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PHARMACOLOGY 

AND 

THERAPEUTICS 



WILCOX 



B\ THE SAME AUTHOR 



MATERIA MEDICA AND PHARMACY 

In the companion book on Materia Medica and 
Pharmacy full attention is given to pharmaceutical 
processes, to the various kinds of preparations, with 
their dosage, and to the art of prescribing ; after which 
the description of remedies is taken up in detail. The 
list of therapeutic agents is divided into two main parts, 
under the heads of Inorganic and Organic Materia 
Medica, and the general classification adopted is one 
based on the groupings of the articles according to the 
class and chemical division or natural order to which 
each belongs. In order to make the book more com- 
plete, condensed descriptions of the action and thera- 
peutic use of all the remedies have been appended. 

The two works combined offer, it is believed, a very 
complete and up-to-date presentation of the whole sub- 
ject of Materia Medica and Therapeutics. 



,' 



PHARMACOLOGY 



AND 



THERAPEUTICS 




BY 

REYNOLD WEBB WILCOX, M.A., M.D., LLD. 

PROFESSOR OF MEDICINE AT THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND 

ATTENDING PHYSICIAN TO THE HOSPITAL; CONSULTING PHYSICIAN TO THE NASSAU 

HOSPITAL; VISITING PHYSICIAN TO ST. MARK'S HOSPITAL; EX-PRESIDENT CF 

THE AMERICAN THERAPEUTIC SOCIETY J FELLOW OF THE AMERICAN 

ACADEMY OF MEDICINE; VICE-CHAIRMAN OF THE REVISION 

COMMITTEE OF THE UNITED STATES PHARMACOPOEIA ; 

ETC. 



SIXTH EDITION 

Based on the Fifth Edition of White and Wilcox' s 
' ' Materia Medica and Therapeutics ' ' 



PHILADELPHIA 
P. BLAKISTON'S SON & CO. 

IOI2 WALNUT STREET 
I905 






*%i 



a* A 



LIBRARY of CONGRESS 
Two Copies Received 

DEC 19 1905 

Copyrizht Entry 

CLASS (X. XXc. No. 

COPY B. 






Copyright, 1905, by P. Blakiston's Son & Co 



"Authority to use for comment the Pharmacopceia of the United 
States of America, Eighth Decennial Revision, in this volume, has been 
granted by the Board of Trustees of the United States Pharmacopoeia! 
Convention, which Board of Trustees is in no way responsible for the 
accuracy of any translations of the official weights or measures or for 
any statement as to strength of official preparations." 



Press of 

The New Era Printing Company 

Lancaster, Pa. 



PREFACE. 



( 



In revising White's Materia Medica and Therapeutics to 
bring it into harmony with the United States Pharmacopoeia, 
so much additional matter has been introduced into the five 
American editions that it seemed advisable to re-write the book. 
The eighth decennial revision of the Pharmacopoeia has given 
the opportunity. /The many advances in the subjects here 
treated have necessitated the division of the work into two dis- 
tinct parts, the first being devoted to Materia Medica and 
Pharmacy, and this, the second, to Pharmacology and Thera- 
peutics. Tt is hoped that this natural separation of the subjects 
will be acceptable to the physician and the student. \/ In the 
present work the classification employed is based on the par- 
ticular physiological systems upon which the various drugs or 
other agents principally act. There is a complete list of drugs 
and preparations, without special description, except as to 
dosage, and very elaborate accounts of their physiological action 
and therapeutics are given. In these descriptions the effort has 
been made to present the latest views of the highest authorities 
in these departments, and to render the book as practically use- 
ful as possible by full details regarding treatment. The two 
works combined offer, it is believed, a very complete and " up- 
to-date " presentation of the whole subject of Materia Medica 
and Therapeutics. 

For valuable assistance, in revision and in proof-reading, the 
author would acknowledge the esteemed services of Doctor P. 
Brynberg Porter. 

The Author. 



CONTENTS. 



Page. 

Definitions i 

Modes of Administration of Drugs 2 

Doses (Posology) 5 

Pharmacological and Therapeutical Actions 8 

Relation between Chemical Constitution and Physiological 

Action 9 

Theory of Ions 10 

Division I. Drugs Acting upon Organisms which Infect the 

Human Body, or upon Processes Going on Outside It... 14 

Antiseptics 14, 19 

Anthelmintics 17, 112 

Antiparasitics 18, 122 

Antiperiodics 18, 128 

Division II. Drugs Acting on the Blood 148 

Drugs Acting on the Plasma 148, 152 

Drugs Acting on the Red Corpuscles '. 149, 220 

Drugs Acting on the White Corpuscles 151 

Division III. Drugs Acting on the Cardiac Mechanism 249 

Drugs Acting upon the Heart Directly 250, 253 

Drugs Acting upon the Vagus Centre 252, 305 

Drugs Acting upon the Accelerating Centre 253, 323 

Division IV. Drugs Acting on the Vessels 324 

Drugs Acting Locally on Vessels 325, 329 

Vaso-dilators 325, 329 

Vaso-constrictors 327, 380 

Emollients and Demulcents 328, 438 

Drugs which act on the Vaso-motor Centres 329 

Division V. Drugs Acting on the Skin 493 

Diaphoretics 494, 496 

Anhidrotics 495 

Drugs Producing a Rash on the Skin 496 

Division VI. Substances Acting on the Urinary System.... 509 

Drugs Increasing the Quantity of Urine Secreted 509, 516 

Drugs Diminishing the Quantity of Urine Secreted 512 

Drugs Rendering the Urine Acid 512 

vii 



Vlll CONTENTS. 

Page. 

Drugs Rendering the Urine Alkaline 512 

Antilithitics 512 

Lithontriptics 513 

Drugs Preventing the Urine from Decomposing 514, 538 

Drugs Altering the Composition of the Urine 514 

Drugs Acting on the Bladder and Urethra 515 

Diuretics 516 

Division VII. Drugs Acting on the Bodily Heat 553 

Antipyretics 553, 556 

Drugs which Cause a Rise of Temperature 555 

Division VIII. Drugs Acting on the Respiration 567 

Drugs Altering the Composition of the Air Inhaled 568 

Drugs Acting on the Respiratory Centre 569, 573 

Drugs Affecting the Bronchial Secretion , 570, 581 

Drugs Relaxing Spasm of the Muscular Coat of the Bronchial 

Tubes, or Antispasmodics 571, 600 

Drugs Acting on the Vessels of the Bronchi 571 

Expectorants 572 

Drugs which May Sometimes Produce Cheyne-Stokes Breath- 
ing 573 

Division IX. Drugs Acting on the Digestive Apparatus 606 

Drugs Acting on the Teeth 606 

Drugs Acting on the Salivary Glands 607 

Drugs Acting on the Stomach 609, 627 

Drugs Acting on the Intestines 617, 680 

Drugs Acting on the Liver 624 

Stomachics 627 

Gastric Sedatives 673 

Purgatives 680 

Laxatives 680 

Simple Purgatives 686 

Drastic Purgatives 697 

Intestinal Antiseptics 7 J 8 

Division X. Drugs Acting on the Nervous and Muscular 

Systems 732 

Drugs Acting on the Muscles 73 2 

Drugs Acting on the Peripheral Endings of Motor Nerves. 732, 744 
Drugs Acting on the Peripheral Endings of Sensory Nerves. 733, 756 

Drugs Acting on the Trunks of Nerves 735 

Drugs Acting on the Spinal Cord 735. 772 

Drugs Acting on the Brain 737, 802 



i 



CONTENTS. IX 

Page. 

Drugs Acting on the Eye 742 

Drugs Acting on the Ear 744 

Drugs Acting. on the Sympathetic System 744 

Drugs Increasing the Irritability of the Anterior Cornua 

of the Spinal Cord 772 

Drugs which Depress the Activity of the Anterior Cornua. 783 

General Cerebral Stimulants 802 

General Cerebral Depressants 843 

General Anaesthetics 888 

Division XL Drugs Acting on the Organs of Generation 908 

Aphrodisiacs 908, 911 

Anaphrodisiacs 909 

Ecbolics or Oxytocics " 909, 919 

Emmenagogues 910, 930 

Substances which Depress Uterine Action 910, 932 

Drugs Acting on the Secretion of Milk 911 

Division XII. Antitoxins and Serums 933 

Division XIII. Organic Extracts 945 

Division XIV. Drugs Acting on Metabolism 960 

Alteratives 960 

Tonics 960 

Division XV. Drugs which Have no Marked Therapeutic 

Properties 986 

Index 997 



PHARMACOLOGY AND 
THERAPEUTICS 



DEFINITIONS. 

Therapeutics. — The application of remedial agents in the 
treatment of disease. It includes : 

General Therapeutics. — The application of curative 
agents other than drugs and medicines. E. g., diet, 
climate, baths, venesection. 
Rational Therapeutics. — Therapeutics based upon Phar- 
maco-dynamics. E. g., the use of digitalis for mitral 
disease. 
Empirical Therapeutics. — Therapeutics based upon clin- 
ical experiences only. E. g., the use of colchicum for 
gout. 
With the exception of such incidental allusion to other 
agents as occasion may require, in this work will be 
considered only that part of Therapeutics which is 
concerned with drugs. 
Pharmacology. — The study of Materia Medica and Thera- 
peutics, including the origin, history, properties and uses of 
drugs and medicines. It includes : 

Pharmacognosy. — The study of the physical and chem- 
ical characters of drugs, and the art of identifying and 
selecting them in accordance with those characters. 
Pharmaco-Dynamics. — The study of the action of 
remedial agents upon the organism of man. or the 
lower animals in a state of health. 
Therapeutics. — Although the correct definition of this 
term is as given above, yet it is. for want of a better 
one. often used as the name of the branch of study 
which deals with Therapeutics. Therapo-Dynamics 
2 i 



2 PHARMACOLOGY AND THERAPEUTICS. 

has been used in the same sense, but is faulty. Expe- 
rimental Therapeutics has been suggested, but is not 
comprehensive. 
Toxicology. — The study of the nature, effects and detection 
of poisons, substances which, introduced into the body inoppor- 
tunely or in excessive amounts, are capable of destroying life. 
Courses of study and treatises upon Toxicology are, for conveni- 
ence, commonly made to include the subject of antidotes and 
treatment, although this is, strictly speaking, a part of Thera- 
peutics. 

Attention must be paid to the manner, quantity and form in 
which drugs are given before entering upon a description of 
their actions and uses. 

MODES OF ADMINISTRATION OF DRUGS. 

(a) Into the blood-vessels by injection. — This method, while fre- 
quently employed in experimental researches upon animals, is resorted 
to only under extraordinary circumstances in the human subject. It is 
most commonly used for infusion of what is known as normal saline 
solution {see Sodium Chloride) after profuse haemorrhage and in vari- 
ous forms of toxaemia. Among the objections to intra-venous injection 
are the difficulty of finding the collapsed veins and the danger, in punc- 
turing a vein, of wounding the opposite wall of the vessel. Again, 
phlebitis is very liable to result, and thrombosis or embolism may pos- 
sibly be caused. As a rule, hypodermoclysis {see below) is therefore 
preferable ; but if the symptoms are very urgent, the tissues cedematous 
from dropsy, or the circulation too feeble to insure absorption, infusion 
should be practiced without hesitation. It is the most prompt method 
in cases of shock, and it has even been proposed, with a view to the 
prevention of shock, that the free use of intravascular hot saline infu- 
sion, injected while the patient is still under the anaesthetic, should be 
adopted as a matter of routine, after all severe operations. This, how- 
ever, should not be practiced before the operation, unless under excep- 
tional circumstances, for the increased arterial tension would be likely 
to cause increased haemorrhage during operative procedures. Intraarte- 
rial, as well as intra-venous, infusion is sometimes practiced. 

{b) Into the subcutaneous tissues by hypodermatic injection. — A 
perfectly clean syringe, fitted with an aseptic hollow silver needle, 
should be used for the injection. A part of the body is selected (com- 



MODES OF ADMINISTRATION OF DRUGS. 3 

monly the external surface of the fore-arm), where the skin is lax. 
The skin is raised between the thumb and forefinger of one hand, and 
with the other hand the needle is inserted under it for about an inch, 
care being taken to avoid muscles and veins. The syringe is slowly 
emptied, then withdrawn, and slight pressure is made for a moment 
over the puncture. The bulk of an injection, as a rule, should be 
about .30 c.c. (5 m.). In order that abscesses may not result, the fluid 
should be aseptic, non-irritating, and free from solid particles. If not 
freshly prepared, it is advisable that a little boric acid should be added 
to it. Much the most convenient and satisfactory plan is to keep the 
drugs for hypodermatic use in the form of soluble tablets, and to dis- 
solve one in the required quantity of water at the time the injection 
is called for. The advantage of this method is that it secures a much 
more rapid absorption than when the drug is given by the mouth, and 
it is ordinarily employed when the promptest possible effects are 
desired. 

Hypodermoclysis. By the bedside is placed an aseptic jar containing 
sterilized warm normal salt saline solution, to which air gains access 
only by means of a glass tube filled with sterilized cotton. From the 
lower part of this vessel extends a tube fitted to a trocar, which should 
be made aseptic. The skin over the part chosen for the infusion (pref- 
erably the ilio-lumbar region — the space between the highest part of the 
crest of the ilium and the lower border of the ribs) having also been 
rendered aseptic, the trocar is thrust into the subcutaneous tissue, and 
the solution allowed to flow at a rate not exceeding 4 c.c. (1 fl. dr.) to 
each 500 gm. (1 pound) of body-weight in each fifteen minutes. The 
necessary pressure is obtained by the elevation of the container, and 
absorption of the fluid is aided by gentle massage. This procedure has 
been employed with advantage to replace the fluid lost from the body 
through haemorrhage or through excessive purging, as in cholera ; also 
to wash from the body various impurities circulating in the blood and 
lymph and to flush the kidneys. It has likewise proved of service in 
cases of surgical shock and of threatened death from anaesthetics. Hy- 
podermoclysis, however, is slower than other methods in shock, on ac- 
count of the poor general circulation, and is also open to the objec- 
tions that the introduction of a proper amount of fluid (1^2 to 2 litres — 
3 to 4 pints) requires quite a number of punctures, which cause pain 
subsequently, and that such a bulk of fluid causes such tension of the 
tissues that at the temperature best adapted to prevent shock (48.8° 
C. — i2o = F.) sloughing may possibly result. 

Enteroclysis is also employed in shock and allied conditions, and not 



4 PHARMACOLOGY AND THERAPEUTICS. 

infrequently in association with intravascular infusion. This consists 
of the irrigation of the intestine, commonly with a saline solution, and 
it is most satisfactorily practiced by means of a double-current tube. 
With a return-flow tube in use the fluid does not cool, since fresh hot 
fluid is continually entering to replace the cooler which passes out. 
The method is of service in warding off shock, and has been resorted 
to for this purpose after surgical operations. 

(c) Into serous cavities by injection. — This method is employed only 
to secure certain local effects in such cavities themselves, as to wash 
out antiseptically the pleura after it has been opened or to cause adhe- 
sive inflammation in the tunica vaginalis by the injection of irritants. 
It has been proposed to introduce hot saline infusion directly into the 
abdominal cavity by means of a hollow needle for the purpose of com- 
bating shock. Also when this cavity is opened, as in coeliotomy, it 
may be flushed with hot saline infusion for the same purpose. 

(d) Into mucous cavities. — The most common way of administering 
drugs is naturally by the mouth, so that they may be absorbed from the 
mucous membrane of the stomach or intestine. Circumstances condu- 
cive to rapidity of absorption are an empty stomach and a ready solu- 
bility of the drug in the gastro-intestinal secretions. When it is in- 
tended that the drug shall act only in the intestine, pills, made pur- 
posely insoluble in the ga*stric fluids, are administered. It is probable 
that some drugs are excreted in the bile by the liver, and so never reach 
the general circulation. Pains should be taken to prescribe drugs in as 
palatable a form as possible and so combined as not to cause irritation. 

It is sometimes advisable to administer drugs by the rectum, supposi- 
tories being employed for solids, and enemata or clysters for liquids. 
The fact must not be lost sight of that they are not then so readily 
dissolved or absorbed as when given by the mouth. 

Drugs are also used for local effects, as by the urethra or vagina 
(injections, bougies, pessaries), or by the respiratory passages (in- 
halations, cigarettes, sprays or nebulae for inhalations; insufflations 
for blowing into the nose, throat and larynx ; pigmenta, gargarismata, 
trochisci, for a local effect on the mouth and pharynx ; nasal douches 
for the nose). Sprays are given by means of an atomizer. Sometimes 
volatile drugs, as ether, chloroform and amyl nitrite, are inhaled for 
their general effect. 

(e) By the skin. — Certain drugs may be absorbed from the skin if 
mixed with some fatty substance, especially hydrous wool-fat. In this 
way mercury may be absorbed by being rubbed in. Some may also be 
absorbed from the skin when they are volatilized. In this way mercury 



DOSES. 5 

is introduced into the system by fumigation. The chief purpose, how- 
ever, for which drugs are applied to the skin is to secure their local 
effects, and for this they are employed in ointments, cerates, plasters, 
etc. 

To the eye and ear they are applied in washes and injections. 

DOSES. 

The study of doses is called Posology. In determining the dose the 
following points deserve attention : 

1. Age. — The adult dose is that for a person between twenty and 
sixty years old, but for women the dose should be somewhat smaller 
than for men. 

For Children under twelve Cowling's rule — divide age at next birth- 
day by twenty-four — is the simplest and is generally of sufficient exact- 
ness. It must be borne in mind, however, that in the case of certain 
drugs the dose may be relatively larger than for adults, while in that 
of others they must be relatively smaller. Thus, children bear iron, 
alcohol, arsenic, belladonna, hydrated chloral, rhubarb, and cod liver oil 
remarkably well, but can take only very small doses of opium and its 
preparations. 

For persons above sixty the dose should be slightly diminished as the 
age advances. 

2. Weight. — In pharmacological experiments upon animals, in which 
it is customary to express the dose as a proportion of the weight, it 
has been found that if the same amount of poison be distributed through 
the tissues of a large individual as of a small one, less is contained in 
any given organ of the former, and less effect is therefore observed. 
This no doubt holds true as regards man also ; so that somewhat larger 
doses of drugs should be prescribed for very large persons than for 
those of ordinary stature, while in the case of persons of unusually 
small size the dose should be proportionately diminished. 

3. Habit. — A person who takes a drug continuously usually becomes 
less and less susceptible to its influence. Thus, an opium habitue after 
a time finds it necessary to use enormous doses of the drug in order 
to secure the desired effect. With strychnine and some other similar 
drugs, however, the susceptibility increases, instead of diminishing, and 
among purgatives cascara sagrada appears to be an exception as regards 
habit. 

■A. Idiosyncrasy. — Many individual differences in the matter of sus- 
ceptibility are met with. These idiosyncrasies, which have frequently 
been observed with almost all commonly used drugs, consist of extra- 
ordinary sensitiveness, or tolerance, or of entirely atypical actions. 



O PHARMACOLOGY AND THERAPEUTICS. 

5. Time of Administration. — Drugs must be given with careful at- 
tention to the time which they require to produce their appropriate 
effects. Thus, some hypnotics have to be administered several hours 
before it is desired that the patient should go to sleep for the night, 
while for others to act but little time is needed. In order to cause 
a morning evacuation of the bowels, slowly acting purgatives must be 
taken the evening before, but promptly acting ones simply before break- 
fast. Drugs which are readily decomposed by the contents of the stom- 
ach should be given when that viscus is empty, preferably a half hour 
before the meal time. Experience has shown that the body is gener- 
ally more resistant in the morning than in the evening, especially in 
the case of narcotic drugs. 

6. Mode of Administration. — Drugs being absorbed much more rap- 
idly from the subcutaneous tissue than from the stomach and upper 
portion of the intestinal canal, smaller doses are required when they 
are administered hypodermatically than by the mouth. On the other 
hand, their absorption is slower from the rectum ; therefore to produce 
the desired effect, the rectal dose must be larger. 

7. Mental Influences. — The mental condition of the patient some- 
times has more or less influence on the effectiveness of drugs. Thus, 
if his mind is particularly fixed on the action of a hypnotic, so that he 
feels convinced that he will sleep, quite a small dose may answer the 
purpose ; but if, on the contrary, he is laboring under considerable 
mental excitement and feels that it is quite impossible for him to sleep, 
an unusually large dose may be required. 

8. Other Temporary Conditions. — Various other temporary condi- 
tions may influence the activity of drugs. As the drug is diluted by 
the stomach contents, absorption takes place more slowly after a meal 
than when the stomach is empty, and any local irritant action is less 
marked. Irritation of the stomach or intestine may also modify the 
effects of drugs, and vomiting and diarrhoea naturally tend to diminish 
their activity by quickly removing them from the alimentary canal. 
During pregnancy drugs must be used with great care. Purgatives may 
induce pelvic congestion, and thus lead to abortion, while drugs causing 
a marked fall of blood-pressure may have the result of asphyxiation of 
the foetus. Drugs acting directly upon the uterus are naturally to be 
avoided, and also those whose effects may be transmitted from the 
mother to the child and do injury to the latter. During lactation cer- 
tain drugs are excreted in the milk, and these may either act on the 
child or render the milk distasteful to it. At the time of menstruation 
all very active drugs must either be given with great caution or tern- 



DOSES. / 

porarily intermitted, and as purgatives tend to increase the flow, they 
should generally be avoided. 

9. Temperature. — The action of drugs often being in part chemical, 
the temperature may be a factor of some importance in determining 
their effects in the case of cold-blooded animals and excised structures, 
but as in man the temperature range is so limited, this element may be 
practically disregarded in Medicine. 

10. Preparation of a Drug. — As a rule, a smaller dose of a soluble 
preparation, as a tincture, will be required than of a solid preparation, 
as a pill, which may be only slowly dissolved before absorption can 
occur, although in the latter case much depends upon the process of 
manufacture. Pills which have been manufactured for a long time may 
be entirely insoluble. 

11. Rate of Excretion'. — In order to produce a prompt effect, a 
smaller dose (other things being equal) will naturally be required of a 
drug that is excreted rapidly than of one the excretion of which is 
slow. It is also true that, in order to maintain a continuous effect from 
drugs which are rapidly excreted, the doses must be repeated at shorter 
intervals. 

12. Cumulative Action. — It sometimes occurs that in a person who 
has been taking a drug for some time without the manifestation of any 
untoward effects, symptoms of poisoning suddenly make their appear- 
ance, or, at all events, that small doses of certain drugs taken repeat- 
edly for a considerable period eventually give rise to symptoms which 
are more marked than those caused by a single dose. Such a result 
is attributed to the cumulative action of the drug, causing an acquired 
susceptibility, in consequence of which a given dose will produce more 
pronounced effects than it did originally. This is the opposite of habit- 
uation, and it may be due to any one of the following causes : (a) 
Greater capacity for absorption than excretion, as in the case of lead 
and mercury. (&) Inconstant absorption, successive doses of the drug 
lying unabsorbed in the alimentary canal until such time as the condi- 
tions, in consequence of some alteration in the intestinal contents, may 
become favorable to absorption, when the whole amount is taken into 
the system at once. This is sometimes met with in the case of digi- 
talis, (c) Summation of effects, the effect of the preceding dose not 
having disappeared when the succeeding dose is given, (d) Sudden 
arrest in the excretion of the drug. For instance, it is thought prob- 
able that in the case of digitalis the renal vessels become contracted 
when the quantity of the drug in the tissues has reached a certain 
amount, so that excretion can no longer take place. It has been sug- 



8 PHARMACOLOGY AND THERAPEUTICS. 

gested also that the organism is subject to what may be called an edu- 
cation to the effects of drugs, particularly in the case of certain ones 
acting upon the central nervous system. Under this hypothesis the fact 
that the susceptibility to strychnine increases with its administration 
would be explained by the central nervous system's becoming educated 
to the stimulating actions and responding more readily to them. Cumu- 
lative action, it should be noted, may occur along with tolerance. Thus 
it is found that the tolerance of certain tissues for nicotine does not 
protect others from the effects of the abuse of tobacco. 

13. Disease. — The action of drugs is liable to be greatly modified by 
disease. This is seen, for instance, in the case of antipyretics, which 
have little or no influence upon normal temperature, but have a pro- 
nounced effect in reducing pyrexia. The dose also must sometimes be 
changed very much on account of the conditions produced by disease. 
Thus, in peritonitis it is a matter of common observation that enormous 
doses of opium are borne perfectly well. The same is true also in many 
instances of hepatic, renal and other very severe forms of colic. 

The tendency of modern therapeutics is towards smaller and more 
frequently repeated doses. 

PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. 

By the action of a drug is ordinarily meant its physiological 
action. 

The primary action is that due to the unaltered drug. The emetic 
action of such drugs as zinc sulphate is an illustration of this. 

The secondary action is that due to compounds formed from the 
drug in the body. Thus, genito-urinary disinfectants like cubeb and 
copaiba owe their effects in this regard to a combination with glycuronic 
acid, in which form they are excreted by the kidneys. 

The local action is that produced at the point of application before 
the drug enters the circulation. 

The direct action is that produced upon organs and tissues with 
which it comes into immediate contact. 

The indirect or remote action is that produced as a secondary result 
of the direct effect. The paralysis of the heart caused by chloroform 
is a direct effect, while the fall of blood-pressure which results from 
this is an indirect effect of the drug. 

The general or systemic action is the effect produced by the drug 
after absorption, and is due to its elective affinity for certain organs 
to which it is carried by the blood. Most active drugs have an elective 



PHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. 9 

affinity for special organs, as the heart or the central nervous system. 
Xot only this, but they attack certain definite tissues. Among those 
which select the central nervous system, for example, some act pri- 
marily upon the cerebral cortex, some upon the medulla oblongata, and 
some upon the spinal cord. It is sometimes the case that a drug has 
the effect of altering different structures in directly opposite ways. 
Atropine depresses the peripheral terminations of the secretory nerves, 
but stimulates the brain, while curara paralyzes the peripheral 
motor nerve endings, but stimulates the spinal cord. Different drugs 
show great differences in the extent of the field of their activity, and 
with most poisons the scope of this depends largely on the quantity 
administered. Hence, one which in small doses affects the medulla 
oblongata only, in larger doses may extend its influence to the brain and 
spinal cord, and when given in still larger amount act also on the heart 
and other organs. It is to be noted that the local effects of a drug may 
be entirely different in character from its general action ; so that while 
it acts as an irritant at the point of application, it may be a depressant 
to the brain when it is carried thence in the circulation. For the rea- 
son that they are not absorbed or are absorbed in inactive forms, some 
drugs have only a local action. Others, again, have only a local action 
because they are excreted or deposited with such rapidity that there is 
not a sufficient quantity in the blood at any one time to produce any 
general effects. Many powerful poisons, on the other hand, show only 
an elective affinity for some internal organ to which they are conveyed 
in the circulation, and have little or no local action. 

Relation between Chemical Constitution and Physiological Ac- 
tion. — While it is true that in a general way drugs closely resembling 
each other as to their chemical composition and properties produce 
similar effects upon the organism, as seen, for instance, in the case of 
the heavy metals, yet it is found that when their physiological action 
is carefully followed* out, considerable differences in their effects are 
discovered. This is due to the circumstance that certain factors are 
met with which are apparently quite independent of their chemical con- 
stitution, or, at all events, which it is impossible to deduce from the 
latter. It is worthy of attention that the position of the radicals in the 
molecule is sometimes of great physiological importance. Thus, resor- 
cinol (metadihydroxy-benzene) has a very sweet taste, while pyrocatechin 
(orthodihydroxy-benzene) is bitter. Moreover, substitution of one radical 
for another in organic compounds often greatly modifies the action. It 
can be stated, then, that it may be inferred with some probability that 
any substance belonging to a chemical group of similar constitution will 



10 PHARMACOLOGY AND THERAPEUTICS. 

give rise to symptoms resembling in general character those of the 
other members of the group, provided that it does not contain some 
radical which renders it inactive or gives it a more powerful action in 
some other direction. At the same time, the details of its action 
can be determined only by actual experiment. It is also equally true 
that the details of the chemical behavior of such substance can be 
ascertained only by performing the necessary reactions, and the point 
has therefore been well taken that as there is no prospect at the present 
time of explaining the latter from its constitution, there is still less 
hope that much advance will be made in the near future in formulating 
the laws governing the details of its pharmacological effects. 

The Theory of Ions. — It remains to speak in this connection of the 
theory of electrolytic dissociation and the underlying doctrine of the 
ions, which, there is every reason to believe, will, by opening up new 
methods of investigation, prove of the utmost importance in elucidating 
certain aspects of physiological action and affording a rational explana- 
tion of many obscure therapeutic facts. Furthermore, it gives promise 
of varied therapeutic possibilities in the future. According to this 
theory, when acids, bases and salts which, since they conduct the elec- 
tric current, are termed electrolytes, are dissolved, either all or a part 
of the molecules are split up by the solvent into simpler substances, 
the electrically charged atoms or groups of atoms known as ions. In 
other words, ions are those constituent parts of the molecules which, 
under the directive influence of an electric current, travel in opposite 
directions through the solution. Those which take on a positive charge 
are called kations, and those assuming a negative charge, anions. A 
simple illustration is afforded in the case of hydrochloric acid, a solu- 
tion of which is made up not only of HC1 molecules, but also of H 
ions and CI ions. When such a solution is completely dissociated, it 
would be put down as H+ and CI — . It is a fact, however, that while 
in a solution of hydrochloric acid there are dissociated chlorine ions, it 
does not contain free chlorine in the condition met with in a solution 
of chlorine gas. In solutions of a chloride the existence of chlorine 
cannot be demonstrated by its physical properties, but its presence can 
always be recognized by its reactions. The circumstance that all chlo- 
rides, by reason of their chlorine, yield a certain set of reactions which 
are precisely the same, whatever the associated element may be, is re- 
garded as one of the strongest proofs of the correctness of the disso- 
ciation theory. Since all chlorides thus give off free chlorine-ions on 
solution, notwithstanding that each one in its solid condition is charac- 
terized by its own special properties, it becomes clear why they present 



PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. I I 

a common set of reactions. The importance is insisted upon of the 
fact that only those portions of the substance which are ionized are 
chemically active, the ionized condition being necessary for the rapid 
reactions which electrolytes display. With the exception of hydrogen 
dioxide, water, the universal solvent of the body, seems to cause the best 
dissociation of molecules into ions. Formic acid comes next in this 
regard, then nitric acid ; methyl alcohol is superior to ethyl alcohol, ace- 
tone and various ethereal salts follow, and the hydrocarbons are of 
only feeble power. It has been found by experiment that only those 
substances which afford abnormal osmotic pressure in solution are capa- 
ble of conducting the electric current, and if they are dissolved in other 
solvents in which they behave normally, they lose this power. With 
our present knowledge concerning the mode of action of electro- 
lytes, it is evident that the ions which conduct the current must al- 
ways be present, i. e., they are not formed by the current. The ions 
naturally act as molecules, and so increase the osmotic pressure. The 
ions which are formed from a substance, it has been shown, must neces- 
sarily be charged very heavily with electricity ; otherwise they would 
not conduct the current. For example, in a solution of acetic acid 
there are undissociated molecules of C 2 2 H 4 and ions of H -f- and 
CH3COO — . Since the ions are charged with electricity, they do not 
behave as they would in the molecular state, i. e., they are not given off 
as gases. Furthermore, it is a fact that some ions are always charged 
with positive electricity, while others are charged with negative ; but no 
ion is known which is 'at one time positive and at another negative. 

The physiological as well as the chemical effects of most of the elec- 
trolytes have been found to be entirely dependent upon their constitu- 
ent ions, quite irrespective of the nature of their molecules. Thus, all 
acids are characterized by H ions, and it is in consequence of this that 
they all have certain general properties, while the differences between 
the solutions of different acids containing the same number of H ions 
depend upon the difference between their anions. The kation of acids 
is hydrogen; the anion of bases is the hydroxyl group (OH). The 
general conclusion to be arrived at is, then, that the physiological effects 
of an electrolyte are for the most part determined by the character of 
its ions. While the principal characteristics of most of the substances 
which are of importance in therapeutics are fairly well known, it is a 
desideratum to understand why or how it is that they produce their 
special effects, and so far as the electrolytes are concerned the theory 
of ions would seem to largely supply such knowledge. For instance, 
the long-recognized community of the reactions of the dissolved salts 



12 PHARMACOLOGY AND THERAPEUTICS. 

of a given metal (being the same with respect to that metal whether 
the chloride, sulphate, nitrate, or other salt is employed), received no 
adequate explanation until the promulgation of this theory. In the solid 
state, and when undissociated in solution, each salt has individual at- 
tributes ; while in dilute solution, when dissociation is usually more or 
less complete, the properties of the salt are merely the sum of the 
properties of its ions. If, therefore, a series of salts contains a com- 
mon ion, the properties of this will be common to all its members. As 
an illustration of this the behavior of iron salts has been cited. While 
all the simple salts exhibit common chemical reactions and have a 
very similar physiological action, compounds such as the ferrocyanides, 
for instance, neither yield the reactions of iron o"r exhibit the influence 
of the metal in their physiological effects. The explanation .would seem 
to be that the simple salts yield metallic ions on dissociation, but the 
ferrocyanides yield the group ferrocyanogen, neither the chemical be- 
havior or the physiological action of which is identical with that of 
iron itself. It is plain that when a dissociable body is administered, 
not one, but two separate agents are put in action in the tissues, so that 
the effect of each of the ions must be taken into consideration. In the 
great majority of such substances in the organic materia medica, how- 
ever, the action of one ion is so much more powerful than the other 
that the less important one may be practically disregarded. This is 
especially true of the more toxic bodies. In the case of morphine sul- 
phate, for instance, while this exists in the body as a morphine and 
a sulphate-ion, the action of the former ion is so much more powerful 
than the other that the sulphate-ion is of no consequence. Evidence 
of this is furnished by the fact that morphine hydrochloride, which in 
the body is dissociated into morphine and chlorine-ions, has practically 
the same action as morphine sulphate. With less poisonous substances, 
however, both the ions may exert a more or less powerful influence. 
Thus, we find that quite different symptoms are produced by potassium 
sulphate and potassium bromide, and this is because here larger amounts 
can be administered, and the S0 4 and Br ions are present in sufficient 
quantities to elicit their specific actions, which are quite as important 
as that of the K-ion. What are ordinarily called the strongest acids 
and the 'strongest bases are those which, in a given solution, are most 
ionized. The effects of an ion can be determined only by administer- 
ing it along with another in the form of a salt, but certain ions, it has 
been pointed out, are so inactive in the tissues that, if any effect is 
noted after a compound of which they form part, the action can be 
ascribed with certainty to the other ion, unless the change arises from 



PHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. I 3 

alteration of the physical properties of the fluids. Thus, the sodium 
ion and the chloride ion have been ascertained to be both practically 
inert, except in so far as they change the osmotic pressure ; hence if 
a sodium salt or a chloride be found to cause some change which is 
not due to the physical alteration, the action is to be attributed to the 
other ion of the molecule. By osmotic pressure is meant the resis- 
tance offered by a non-permeating salt to the passage through a partially 
permeable membrane of the fluid in which it is dissolved ; and this varies 
with the number of molecules and ions. (For additional remarks on 
the subject of osmosis see Sodium Chloride.) 

Some further points deserve attention. Many observations point to 
the conclusion that the irritability of muscle and nerve depend upon 
the presence in them of compounds of proteid with the various ions, 
sodium, potassium and calcium, in definite proportion. Furthermore, 
it has been demonstrated by experiment that the physiological effects 
of certain drugs can be modified in definite ways by the addition of 
chosen radicals to the molecule. Thus, the convulsive action of strych- 
nine, brucine and thebaine on the spinal cord is changed to a paralyzing 
effect by the introduction of methyl into the molecule. Again, the in- 
troduction of chlorine-ions into certain fatty molecules increases their 
narcotic and toxic properties. The results of these recent investiga- 
tions would seem to afford ground for the opinion that in the forces 
of ionic attraction and repulsion is to be found the explanation of the 
rouleau formation of red blood-corpuscles, the agglutination of bacteria 
in appropriate media, and the obscure facts of chemotaxis, illustrated 
by the attraction or repulsion which certain chemical media have for 
some bacteria and for leucocytes. Protoplasmic movements doubtless 
take place by means of ions, the electricity-bearing portions breaking 
down when in solution, and it has been suggested that toxic and anti- 
toxic effects may be due to various alterations in the composition of 
protoplasm forming living tissue. If a toxin which depends for its 
activity on a large number of monovalent anions can be controlled, by 
a small number of bivalent anions, or even ions of much higher valence 
(thus requiring a smaller quantity), the question of remedy is apparent. 
So, among "antiseptics, picric and salicylic acids may be destructive to 
low forms of life because they are easily dissociated in the tissue elec- 
trolytes and liberate large numbers of poisonous hydrogen kations. 
Mercuric bichloride and copper kations are for the same reason effec- 
tive, but the solution of a mercury salt in strong alcohol (a substance 
in which no electrolytic dissociation occurs) has no germicidal proper- 
ties. The neutralization of the effects of carbolic acid by concentrated 



14 PHARMACOLOGY AND THERAPEUTICS. 

alcohol is susceptible of a similar explanation. Under ordinary condi- 
tions, ions of high valence are markedly disinfectant ; those of lower 
valence less so. As regards mercury salts, dissociation may be re- 
tarded by the introduction into an aqueous solution of either alcohol 
or of another salt dissociating the same anions. For example, calomel 
treated with increasing proportions of sodium chloride shows a steady 
decrease of toxicity, the cause of which is the progressive suppression 
of the formation of mercury ions. The dissociating power of a solvent 
is believed to be a function of all the physical or chemical properties 
of a substance, and not of any one of them. The results of a great 
number of experiments all tend to demonstrate the chemical inertness 
of molecules. As the reactions proceed, and the ions already present 
are used up, it is found that the molecules are gradually dissociated and 
furnish new ions, which then enter into the reaction. The chemistry 
of atoms and molecules has thus given place to the chemistry of ions. 

The classification of drugs which is adopted here is one in accordance 
with the parts on which they act. 

Division I. — Drugs acting upon Organisms which infect 
the Human Body, or upon Processes going on outside it. 

A. Antiseptics are drugs which prevent the growth of micro- 
organisms, destroy or render innocuous the toxic products of 
their action upon the tissues of the body, or interfere with the 
absorption of such products. By some the use of the word 
antiseptic is limited to those substances which restrain the de- 
velopment of micro-organisms, while those which destroy the 
vitality of the latter are designated as germicides or disinfect- 
ants. The term disinfectant, by extension, is applied to those 
agents which kill non-pathogenic bacteria, as well as to those 
which destroy disease germs. Much discrepancy of statement 
is to be found regarding the fact of certain drugs being really 
antiseptics and as to the relative power of various antiseptics, 
owing to the circumstance that antiseptics act differently upon 
different organisms, while the difference between inhibiting the 
growth of micro-organisms and destroying their vitality has 
been lost sight of. There are also certain factors determining 
the efficiency of an antiseptic which ought to be taken into 
consideration. Among these are the following: The nature of 



DRUGS ACTING UPON INFECTIOUS ORGANISMS. . I 5 

the antiseptic agent, the strength in which it is used, the temper- 
ature at which it acts, the nature and number of the micro- 
organisms, the nature and quantity of the associated material, 
and the time of exposure. In testing the value of any antiseptic 
it is requisite that all instruments and substances employed in 
the procedure should first be exposed to a temperature sufficient 
to destroy any adventitious bacteria. A cultivating medium, 
such as agar-agar jelly, having been placed in two test-tubes, 
the substance to be tested, in suitable solution, is added to one 
of them ; after which some fluid containing the micro-organisms 
selected is poured into both the tubes. Both are then plugged 
with sterilized cotton to prevent the entrance of germs from the 
air, and observation from time to time will show how far the 
development of the micro-organisms has been interfered with 
by the supposed antiseptic. As the potency of an antiseptic is 
dependent upon so many circumstances, it is impossible to deter- 
mine with exactness the relative efficiency of various agents. 
In the following list some of the most powerful and generally 
used antiseptics are placed first. 

1. Heat is the best antiseptic, but there must be a temperature of 
at least ioo° C. (212 F.). Infected clothing, bedding, etc., may be 
heated in a dry-air chamber to between 93. 5 and 149 C. (200 and 
300 F.), but, on account of its superior penetrating qualities, steam, 
driven, under pressure, through the articles is decidedly preferable. In- 
stead of this, the infected material may be boiled in water. Surgical 
instruments are generally disinfected in this way, but one per cent, of 
washing soda (sodium carbonate) should be added to the water to pre- 
vent their rusting. 

2. Corrosive Mercuric Chloride. — A solution of 1 in 1000 is com- 
monly used for disinfecting the hands and is sometimes employed in 
surgery and obstetrics. For most uses, however, one part to 3000 or 
5000 of water, or even weaker, is the limit of safety. Gauze of the 
strength of 1 to 2000 will blister, if the skin is damp. 

3. Formaldehyde, the official solution of which contains at least 37 
per cent., by weight, has extraordinary power as a surface disinfectant, 
greater indeed than that of any known substance. . It is especially use- 
ful for the disinfection of rooms and their contents when volatilized 
from a specially constructed lamp. 



1 6 PHARMACOLOGY AND THERAPEUTICS. 

4. Chlorine for most purposes is too irritating, but the gas (which 
is generated by the action of hydrochloric acid on potassium chlorate 
or manganese dioxide) may be used to disinfect rooms. It is open to 
the objection that it attacks and bleaches many substances. 

5. Phenol, or Carbolic Acid, is used but infrequently. If surgical 
instruments have been previously sterilized, the use of phenol indicates 
a distrust, on the part of the surgeon, of his assistants. 

6. Lysol, 7, Creolin, and various cresol compounds are powerful anti- 
septics and employed to a large extent. 

8. Chorinated Lime is the best antiseptic for all excreta. 

9. Bromine, and, 10, Iodine, are rarely used, as they are too irri- 
tating. 

11. Quinine, and, 12, Salicylic acid, are too expensive for ordinary 
use. 

13. Iodoform is used for dusting upon wounds, sores, etc., but is 
objectionable on account of its extremely disagreeable odor. It should 
be previously sterilized. 

14. Boric acid is used for many surgical purposes. Since in about 
a two and one-half per cent, solution it inhibits the growth of most 
bacilli, it may be employed to preserve solutions intended for hypoder- 
matic use. 

15. Zinc chloride, and, 16, Potassium permanganate, are much used 
for domestic purposes. 

17. Solution of Hydrogen dioxide is the principal ingredient of 
various popular disinfectants. 

18. Sulphurous acid, generated by the burning of sulphur, is used to 
disinfect rooms. It should always be associated with moisture. 

19. Creosote, 20, Benzoin, 21, Zinc sulphate, 22, Ferric oxide, 23, 
Thymol, 24, Alcohol, 25, Balsam of Tolu, 26, Balsam of Peru, are not 
much used. 

As to internal antisepsis, the objection has often been raised 
that there are no known drugs which when swallowed or inhaled 
will with certainty destroy micro-organisms, either in the gastro- 
intestinal tract or respiratory passages, unless they are suffici- 
ently concentrated to injure or prove fatal to the patient. By 
some authorities, however, it is claimed that calomel, naphthol 
and some other agents are capable of destroying certain varieties 
of micro-organisms in the stomach and intestines ; and, whether 
this is the case or not, it is undoubtedly a fact (and one that is 



DRUGS ACTING UPON INFECTIOUS ORGANISMS. 1/ 

often lost sight of) that an infinitely small amount of a remedy 
which could not be administered in sufficient amounts to destroy, 
will often completely inhibit the growth of micro-organisms. 
Such drugs should therefore be classed as internal antiseptics. 

Antizymotics are agents which arrest fermentation, and are 
sometimes divided into two groups, antiseptics and disinfectants. 
The fermentative processes may be caused by organized fer- 
ments, such as bacteria and the yeast-plant, or by unorganized 
ferments (enzymes), such as pepsin, diastase, ptyalin, etc. 

Deodorants, or deodorizers, are substances which destroy foul 
smells. The volatile deodorants are mainly oxidizing and 
deoxiding substances which act chemically on the noxious 
effluvia, while the non-volatile deodorants are mainly absorbents, 
which condense and decompose them. Many antiseptics and 
disinfectants are also deodorants. Charcoal is often called a 
disinfectant, but is merely a deodorizer. 

B. Anthelmintics are agents which kill (vermicides) or expel 
(vermifuges) parasitic worms infesting the alimentary canal. 
Three kinds only of such parasites are commonly met with in 
the temperate zone : 

(i) Tape-worm (Tenia solium and Tenia mediocanellata). Anthel- 
mintics: Aspidium (mostly used), Oleum Terebinthinse, Kamala, 
Cusso, Granatum, Pelletierine Tannate (easily administered and very 
efficient), and Pepo. 

(2) Round-worm (Ascaris lumbricoides). Anthelmintics: Santonin, 
Chenopodium, and Spigelia and Senna. 

(3) Thread-worm (Oxyuris vermicularis). Anthelmintics: Rectal in- 
jections of salt water, infusion of quassia, solutions of iron salts, or 
diluted oil of turpentine are commonly recommended. It is probable, 
however, that ordinary rectal injections are useless. Large soap and 
water enemata, the patient being in the knee-chest position, give the 
best results. Lime water is often very efficient. In the case of chil- 
dren it is advised that the lower bowel should be first emptied by an 
injection of warm soap and water. The child should then be placed 
upon a bed with its buttocks elevated, and the tube of the syringe be 
passed gently within the inner sphincter. The fluid (soap and water, 
lime water, or salt and water), previously warmed, must be injected with 
some little force, so that it may be lodged in the upper part of the rec- 



I 8 PHARMACOLOGY AND THERAPEUTICS. 

turn ; otherwise expulsive efforts will be immediately excited. It is best 
that the enema should be given at bedtime in order that it may be re- 
tained for a sufficient length of time. 

Anthelmintics for the tape or round-worm should be given 
when the alimentary tract is empty, to ensure their coming 
in contact with the parasite, and a purgative is therefore 
usually given a few hours before the anthelmintic. If the latter 
is itself not also a cathartic, another dose of purgative medicine 
should be administered after it, to bring away the worm or 
worms. When aspidium is employed castor oil should always 
be avoided, as its use is attended with considerable danger. In 
the case of tape-worm, in order to see whether the head is dis- 
charged, each stool should be received into a separate vessel, 
then mixed with water, and filtered through coarse muslin. 

C. Antiparasitics or parasiticides are substances which destroy 
parasites. The term is usually applied to those which are 
destructive to the animal and vegetable parasites found upon 
the cutaneous surface. 

(i) For the various forms of tinea the following are used: Mercurial 
preparations, especially the oleate, tincture of iodine, glycerite of 
phenol, an ointment of pyrogallic acid, a boric acid lotion, a sali- 
cylic acid lotion, sulphurous acid, formaldehyde and thymol; and 
if the patches are small, severe irritants, as croton oil, cantharides, 
and chrysarobin ointment. Tinea versicolor never requires severe 
irritants. 

(2) As parasiticides for itch, sulphur ointment, Balsam of Peru, and 
Styrax are all effectual. 

(3) Pediculi vestimentorum will be killed by any mild parasiticide. 
Unguentum Staphisagriae, unofficial ; 1 part powdered seed, 2 parts each, 
olive oil and lard, is often used. 

(4) Pediculi capitis and pediculi pubis are also easily killed by mild 
parasiticides ; mercurials or Unguentum Staphisagriae are commonly 
employed. 

D. Antiperiodics are drugs which in diseases which recur 
periodically lessen the severity of the paroxysms or arrest their 
return. Some, and probably all, act as direct poisons to the 
micro-organism causing the disease. 



MERCURY. 19 

They are cinchona bark, quinine and its salts (by far the most pow- 
erful), quinidine, cinchonine, cinchonidine, arsenic trioxide, eucalyp- 
tus, hydrastis, salicin, salicylic acid, and berberine. They are used 
for all forms of malarial fever and neuralgia. 

(All doses of official drugs and preparations are to be under- 
stood as the " average approximate (but neither a minimum nor 
a maximum) dose for adults.") 

A. Antiseptics. 
MERCURY. 

1. HYDRARGYRUM.— Mercury. (Quicksilver.) 

Preparations. 

1. Emplastrum Hydrargyri. — Mercurial Plaster. 

2. Unguentum Hydrargyri. — Mercurial Ointment. 

3. Unguentum Hydrargyri Dilutum. — Blue Ointment. 

4. Hydrargyrum Ammoniatum. — Ammoniated Mercury. 
(White Precipitate. Mercuric Ammonio-Chloride.) 

5. Unguentum Hydrargyri Ammoniati. — Ointment of Am- 
moniated Mercury. (White Precipitate Ointment.) 

6. Hydrargyrum cum Creta. — Mercury with Chalk. (Gray 
Powder.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

7. Massa Hydrargyri. — Mass of Mercury. (Blue Mass.) 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

2. HYDRARGYRI CHLORIDUM CORROSIVUM. — Corrosive 

Mercuric Chloride. (Corrosive Sublimate. Mercuric Bichloride. Cor- 
rosive Chloride of Mercury.) Dose, 0.003 gm. (3 milligm.); Y V §*• 

3. HYDRARGYRI CHLORIDUM METE.— Mild Mercurous Chlo- 
ride. (Calomel. Mild Chloride of Mercury. Subchloride of Mercury.) 
Dose (laxative), 0.125 gm. (125 milligm.); 2 gr.; (alterative), 0.065 
gm. (65 milligm.); 1 gr. 

Preparation. 

Pilulae Catharticse Composite.— Compound Cathartic Pills. 
Dose, 2 pills. 



20 PHARMACOLOGY AND THERAPEUTICS. 

Preparation. 

4. HYDRARGYRI IODIDUM FLAVUM.— Yellow Mercurous Io- 
dide. (Mercury Protiodide. Yellow or Green Mercury Iodide.) Dose, 
0.010 gm. (10 milligm.); y 3 gr. 

5. HYDRARGYRI IODIDUM RUBRUM.— Red Mercuric Iodide. 
(Mercury Biniodide. Red Iodide of Mercury.) Dose, 0.003 gm. (3 
milligm.); ^ gr. 

Liquor Arseni et Hydrargyri Iodidi. — Solution of Arsenic 
and Mercuric Iodides. (Donovan's Solution.) Dose, 0.1 C.C.; 

6. HYDRARGYRI OXIDUM FLAVUM.— Yellow Mercuric Oxide. 

Preparations. 

1. Unguentum Hydrargyri Oxidi Flavi. — Ointment of Yel- 
low Mercuric Oxide. 

2. Oleatum Hydrargyri. — Oleate of Mercury. 

7. HYDRARGYRI OXIDUM RUBRUM.— Red Mercuric Oxide. 
(Red Precipitate.) 

Preparation. 
Unguentum Hydrargyri Oxidi Rubri. — Ointment of Red 
Mercuric Oxide. (Red Precipitate Ointment.) 

8. LIQUOR HYDRARGYRI NITRATIS.— Solution of Mercuric 
Nitrate. 

9. UNGUENTUM HYDRARGYRI NITRATIS. — Ointment of 
Mercuric Nitrate. (Citrine Ointment.) 

Unofficial Preparations. 

Ammoniae et Hydrargyri Chloridum. — Ammonio-Mercuric 
Chloride. (Sal Alembroth.) 

Emplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890). — 
. Ammoniac Plaster with Mercury. 

Hydrargyri Carbolas. — Mercuric Carbolate. Dose, 0.02 to 
0.03 gm.; y, to y 2 gr. 

Hydrargyri Cyanidum (U. S. P., 1890). — Mercuric Cyanide. 
Dose, 0.001 to 0.008 gm.; ^ to T \ gr. 

Hydrargyri et Zinci Cyanidum.— Mercuro-Zinc Cyanide. 

Hydrargyri Formamidas. — Mercuric Formamidate. Dose, 
hypodermatically, 1 C.C.; 15 tl\,. 



MERCURY. 2 1 

Hydrargyri Oxidum Nigrum. — Black Mercurous Oxide. 

Hydrargyri Subsulphas Flavus (U. S. P., 1890). — Yellow 
Mercuric Subsulphate. (Turpeth Mineral.) Dose, 0.12 to 0.21 
gm.; 2 to 4 gr., as an emetic. 

Hydrargyri Sulphidum Rubrum. — Mercuric Sulphide. (Cin- 
nabar. Red Sulphide of Mercury.) 

Hydrargyri Tannas. — Mercurous Tannate. Dose, 0.06 to 0.12 
gm.; 1 to 2 gr. 

Hydrargyrol. — Hydrargyrol. (Mercury Paraphenylthionate.) 

Hydrargyrum Colloidale. — Colloid Mercury. Dose, 0.09 to 
0.18 gm.; iy 2 to 3 gr. 

Lotio Hydrargyri Flava (B. P.). — Yellow Mercurial Lotion. 
(Yellow Wash.) 

Lotio Hydrargyri Nigra (B. P.). — Black Mercurial Lotion. 
(Black Wash.) 

Mercurol. — Mercurol. 

Pilulae Antimonii Compositae (U. S. P., 1890). — Compound 
Pills of Antimony. Dose, 1 to 3 pills. 

Action of Mercury and its Salts. 
External. — Locally the metal itself and many of its salts are 
inert. The action of others varies from that of a mild stimu- 
lant to the effect of a powerful irritant and escharotic. Thus, 
the acid solution of mercuric nitrate is strongly caustic. Mer- 
cury and its salts are readily absorbed by the skin, so that the 
physiological effects of the drug can all be produced by inunc- 
tion. When metallic mercury, rubbed into fine globules, is 
applied to the integument in ointment, it passes into the gland 
ducts and along the roots of the hairs, and, after being oxidized. 
is dissolved and taken up into the tissues. It is also possible 
for the vapor to be absorbed by the mucous membrane of the 
lungs, and this pulmonary absorption of the drug is not at all 
uncommon when mercurial preparations (many of which are 
very volatile) are applied to the skin. Some of these prepara- 
tions, when thus locally applied, have considerable efficiency in 
allaying itching, however produced, and a large number of 
them (among which may be mentioned the oleate, oxide, am- 



22 PHARMACOLOGY AND THERAPEUTICS. 

moniate and corrosive chloride) are anti-parasitic, destroying 
the animal and vegetable parasites which infest the skin. 
Mercury, it has been proved, is possessed of great germicidal 
power. 

Lower Forms of Life. — Its germicidal potency is due to the 
fact that it is poisonous not only to the higher plants and ani- 
mals, but also to lower organisms. Whenever it comes into 
intimate contact with albumins, it forms the albuminate and 
destroys life, and there can be no question that corrosive mercu- 
ric chloride and the other soluble salts of mercury are among 
the most important antiseptics at present known. It has been 
demonstrated that the bichloride in the strength of i to 50,000 
destroys infusoria in about twenty minutes, and that even a 
solution of one part in one million destroys algae in the course 
of a few days. While the bacteria are somewhat more resist- 
ant than these, it is claimed that a solution of 1 to 1,000,000 will 
delay the development of some of them, and the anthrax 
bacillus, it has been found, fails to grow in blood which con- 
tains 1 part in 8,000. At the same time, it is now regarded as 
indubitable that the germicidal power of the bichloride has been 
considerably over-estimated; for, while it has been commonly 
accepted that a strength of 1 to 1,000 is sufficient to completely 
disinfect fluids within a few hours, it has been proved that 
anthrax spores, after having been exposed to the action of a 1 
per cent, solution for many hours, are still capable of develop- 
ing as soon as the antiseptic is removed. Calomel, it has been 
demonstrated, has some effect as an intestinal antiseptic; but, 
owing to the difficulty of bringing them into intimate contact 
with the microbes, the insoluble salts are naturally much less 
efficient as germicides than the soluble ones. 

Internal. — Mercury, unlike other metals, has, as is shown by 
its powerful germicidal influence, a strong specific action on 
protoplasm, and this property is due to its marked affinity for 
nitrogenous molecules. While its different salts have different 
external actions, yet after absorption their effects on the sys- 
tem are as a rule much the same. Both the local and general 



MERCURY. 23 

effects of a soluble salt, such as the bichloride, are more pro- 
nounced than those of one like calomel (which is entirely in- 
soluble in water) since it comes into more intimate contact with 
the tissues, and so acts more energetically locally, while it is 
also absorbed more rapidly and in larger amount. When, how- 
ever, a sufficient quantity of mercury in the form of calomel 
has been absorbed, the general effects are the same as if an 
equal amount had been taken up by the tissues as perchloride. 
When mercury is absorbed, it has been shown that it circulates 
in the blood in the form of the albuminate, which is insoluble 
in water, but is rendered soluble by excess of proteid, and, also 
by such quantities of sodium chloride as are met with in the 
tissues. It has- a marked corrosive action, which, as has been 
pointed out, is the more powerful because the precipitate formed 
with proteids is less insoluble in the surrounding fluids of the 
body, and is therefore more flocculent and affords less protec- 
tion to the surface, than those formed by the other heavy 
metals; so that this destructive influence is not limited to the 
surface of a tissue, but extends into the deeper cells. 

Absorption and Elimination. — When mercury is administered 
regularly for a considerable time, elimination, which appears to 
take place irregularly and intermittently, fails to keep pace with 
absorption. It disappears from the blood and is then deposited, 
in less soluble form, in the tissues and organs, and it has been 
found that this accumulation is especially liable to occur in cer- 
tain parts of the body like the kidneys, the intestinal walls, the 
liver, the spinal cord, and the medullary cavities of long bones. 
Absorption of the drug may take place from all surfaces, and 
is said to be especially rapid from serous ones. It is excreted 
principally by the bowels, but also to some extent in the urine, 
saliva, perspiration and milk. The excretion by the kidneys, 
which begins in about two hours after ingestion, has been 
noted as long as six months after the use of mercury has been 
discontinued. Mercury has been found in serum and in pus 
from ulcers. 

Alimentary Tract. — The first evidences of mercurialism are 



24 PHARMACOLOGY AND THERAPEUTICS. 

met with in the mouth. The initiatory symptoms are usually 
a slight fetor of the breath, which is sooner or later accom- 
panied by a disagreeable metallic taste, and tenderness of the 
teeth when they are forcibly brought together or knocked with 
a metallic substance. These are followed by stomatitis, spongi- 
ness of the gums, swelling of the tongue, and profuse salivation. 
That this condition is not due to any local action of the mercury 
is shown by the fact that it results in exactly the same way 
when the drug is administered by inunction or by subcutaneous 
injection. The salivation is apparently due to the direct effect 
of the agent on the secretory apparatus, and sometimes it is the 
very first symptom to make its appearance. If the administra- 
tion be continued, the quantity of saliva poured out becomes 
enormous; it is altered in character, contains mercury, and 
irritates the skin over which it flows. The fetor is excessive 
and the gums are intensely inflamed, being marked by a dark 
red line at the junction of the teeth, and bleeding at the 
slightest touch. Both the parotid and submaxillary glands are 
enlarged and tender. The teeth become loosened in their 
sockets and may drop out, and excoriations caused by the irri- 
tation of the drug lead to the formation of ulcers, particularly 
where there are accumulations of microbes, as around carious 
teeth. Finally, the maxillary bones undergo necrosis, as a re- 
sult of the penetration of these ulcers, which sets up periostitis. 
Children under the age of three years are seldom salivated, but 
they are not exempt from the other effects of mercury on the 
system. In the stomach the action of the drug is less marked 
than in the mouth, but it may produce more or less hyperemia, 
and in cases of poisoning this is accompanied by small haemor- 
rhages. In the small intestine also it has comparatively little 
effect, but in the caecum and colon it gives rise to well-marked 
lesions. These consist of congestion and tumefaction of the 
mucous membrane, which later result in necrotic patches of 
considerable extent and ulcers about the folds; the appearances 
presented being practically identical with those met with in 
chronic dysentery. Perforation of the gut may eventually 



MERCURY. 2 5 

occur. The intestinal inflammation is naturally accompanied by- 
excessive purging and intense abdominal pain, with tenesmus. 
The stools, which are fluid in character and sometimes present 
a rice-water appearance, contain blood, mucus and shreds of 
mucous membrane. Small doses of the insoluble salts, how- 
ever, usually cause loose passages without any griping or strain- 
ing. They pass through the stomach undissolved, it is be- 
lieved, but in the intestine, where time is afforded for the ex- 
ercise of their affinity for epithelium, they become partially dis- 
solved and produce the characteristic irritant effect of the drug. 
While a small proportion of such preparations is absorbed from 
the bowel, by far the greater part passes off unchanged in the 
faeces. It is possible, therefore, for very large doses of calomel 
to be taken without giving rise to any serious disturbance of 
the system. That salt, it has been found, exerts no action on 
the digestive ferments, but it has the effect of limiting the 
decomposition of food by retarding putrefaction in the intestine ; 
its antiseptic action being aided by the removal of the decom- 
posing mass in consequence of the increased peristalsis which 
iv induces. After the use of calomel a diminution of the double 
sulphates in the urine is noted, and this is to be attributed as 
much to its cathartic as to its antiseptic qualities. When calo- 
mel is administered it is likely that a small portion will be 
changed into the corrosive chloride, thus enhancing its anti- 
septic effects. Further, it should be noted that the same 
transformation may take place after prolonged trituration with 
milk sugar. 

Liver. — At the present time it is held that there is no 
sufficient evidence, either experimental or clinical, to show 
that, with the exception of the corrosive chloride, which in- 
creases the biliary secretion, the liver is in any way directly 
affected by mercurials. It was formerly universally believed 
and taught that calomel and some of the other mercurial purges 
increase the secretion of bile, but this has been demonstrated, 
both in the case of man and of animals, to be a mistake. This 
opinion was apparently based on the spinach-green color of 



26 PHARMACOLOGY AND THERAPEUTICS. 

the stools after the administration of calomel, but the latter 
is now known to be due to the circumstance that the bile is 
preserved by this drug from putrefaction in the intestine. 
Mercury, it has been shown, acts in the bowel even when the 
bile is suppressed, and the stools are often of a greenish color, 
which has been thought to be due to a metallic compound formed 
in the bowel, but which really results from bile pigment. Com- 
monly this is decomposed by the microbes in the intestine, with 
the formation of the faecal pigment, but mercury prevents, by 
its antiseptic properties, the growth of the microbes, and the 
bile therefore appears in the stools undecomposed and having 
its ordinary color. It is true that so-called " biliousness " is 
very frequently relieved by mercurials, but this is readily ex- 
plained by the fact that the condition thus designated is one not 
dependent upon the liver, but a disorder of the alimentary tract. 
In this and other affections where the good effects of mercury 
were supposed to be due to its power to increase the flow of bile, 
equally satisfactory results may be obtained by the use of 
other remedies not regarded as cholagogues. At the same time, 
it is true, as mentioned, that the corrosive chloride does actu- 
ally have some effect in increasing the amount of bile, and it 
may possibly be the case that occasionally when calomel is 
administered, some of it, owing to the presence of special condi- 
tions, is converted into that salt. 

Kidneys. — Although it has recently been shown that mercury 
in the form of calomel has a decided diuretic action in rabbits, 
in other animals and in the normal human subject it generally 
has but a comparatively feeble influence on the kidneys. When 
dropsy due to cardiac disease is present, however, it has been 
found that a moderate dose of calomel induces marked diuresis. 
In the accumulations of fluid resulting from cirrhosis of the 
liver and from renal disease its action in this respect is much 
less constant, but in many instances is still quite pronounced. 
While the question has not as yet been definitely determined, it 
seems probable that, since calomel and other salts of mercury 
are known to have an irritant effect upon the kidneys, the 



MERCURY. 27 

diuresis produced by them is due to their direct action upon the 
renal epithelium. When small amounts of mercury are taken, 
the excretion of the drug by the kidneys has not been found to 
cause any pathological changes in the organs, but if the ad- 
ministration is continued for a considerable length of time, it 
gives rise to interstitial and glomerular nephritis; while large 
amounts induce parenchymatous nephritis with glycosuria. The 
relative quantity of mercury excreted by the kidneys is said to 
be increased by the inflammatory changes occasioned. In acute 
mercurial poisoning, when death does not result in a few hours, 
anuria is frequently observed. While the whole kidney is con- 
gested and the glomeruli are acutely inflamed, the most dis- 
tinctive feature met with is a necrosis of the epithelium of the 
tubules in portions of the cortex; and the anuria is the result 
of these pathological changes. As in the case of certain other 
drugs, such as bismuth and aloin, there is sometimes a deposit 
of lime in the kidneys. In mercurial poisoning this is very 
generally noted in rabbits, but less frequently in dogs and in 
man. When it occurs, the tubules are found to be filled with 
a deposit of calcium phosphate, which is occasionally mixed 
with some chalk. It is thought most probable that this is 
thrown out in the necrosed cells and that, as these break up, 
it passes into the tubules. As a rule, the more marked the 
intestinal disturbance, the less pronounced are the destructive 
changes in the kidney in cases of poisoning, and it has been 
found that the latter changes are most frequently caused by 
corrosive mercuric chloride. 

Nervous System. — Mercury has comparatively little effect 
on the central nervous system. In acute poisoning the only 
symptoms observed are secondary to the fall of blood-pressure, 
while consciousness is preserved to the last. In chronic poison- 
ing, however, there are not infrequently noticed tremor, 
erythism and hallucinations, which appear to be of central 
origin. Sometimes there is a dulling of the faculties. The 
general muscular weakness observed is believed to be due, not 
to any affection of the peripheral muscles and nerves, but to 



28 PHARMACOLOGY AND THERAPEUTICS. 

alterations in the centres. The paralysis which is sometimes 
seen in the limbs of workers in mercury has, on the other hand, 
been attributed to the action of the drug on the peripheral 
nerves, destroying the myeline sheath, and the areas of partial 
anaesthesia and the pains in the joints are also probably due 
to peripheral changes. When peripheral neuritis occurs, it 
takes place much later than in the case of lead poisoning. In 
man the muscles do not appear to be directly acted upon in 
either acute or chronic poisoning. Even when paralysis is 
developed, they maintain their irritability and do not undergo 
atrophy. In some instances, especially when the tremor is pro- 
nounced, the reflex excitability of the spinal cord is found to be 
exaggerated, but as a rule it remains unaffected. 

Circulation and Respiration. — In some cases of acute poison- 
ing patches of fatty degeneration have been found in the heart. 
For the most part, mercury has but little direct action on the 
circulation, and such changes as occur in the pulse are attri- 
butable to the shock and collapse in acute, and to the cachexia 
and malnutrition in chronic, poisoning. When general poisoning 
is caused by the intravenous injection of the drug, however, it 
is found that there occurs a very marked fall of blood-pressure, 
which is due to a direct paralyzing action on the heart (involv- 
ing both ganglia and muscle) and on the blood-vessels. The 
respiration is affected only indirectly. The marked breathless- 
ness which is sometimes observed in cases of chronic poisoning 
has been ascribed to the general muscular weakness. 

The Blood and Nutrition.— In health the red corpuscles and 
the haemoglobin appear to be at first augmented and afterwards 
diminished, and while the number of newly formed leucocytes 
has been found to be increased, this is more than counterbal- 
anced by the decline in the older cells. In syphilis it has been 
noted that a pronounced decline in the amount of haemoglobin 
is followed by an increase to beyond that present before the 
treatment was commenced, while there have been found fewer 
newly formed leucocytes, and more mature ones, after mercury. 
It would appear, therefore, that the blood reaction is different 



MERCURY. 29 

in health from that in syphilis, and that it varies in the succes- 
sive stages of that disease. Large doses of the drug destroy the 
crasis of the blood and impair the general nutrition. Whether 
mercury affects the nutrition in any way except through its 
action on the alimentary canal is not definitely known. It has 
been stated by some authors that the urea is increased by the 
use of small doses, but the investigation of these metabolic 
effects is very inconclusive and difficult, on account of the ex- 
tensive action of mercury on the kidneys and intestine, and 
the prolonged administration of the drug is necessarily restricted 
to experiments on animals and on syphilitics. Very small doses 
may perhaps act in much the same manner, and have the same 
beneficial effect upon metabolism, as small doses of arsenic, the 
subject gaining in weight, etc. It seems to be fairly well 
established that in animals, at all events, the nutrition and 
weight are increased by minute doses of mercury given for 
some time. Chronic mercurial poisoning affects metabolism 
profoundly, producing marked cachexia. 

The Skin. — The excretion of mercury through the skin may 
produce various cutaneous affections. The most common erup- 
tion is a polymorphic erythema, more or less resembling that 
of scarlet fever. In other cases it is erysipelatous in charac- 
ter, with subcutaneous cedematous swelling, and still other 
forms are urticaria, roseola, pemphigus and purpura. Some- 
times there is produced a very severe eczema, which eventually 
becomes pustular, and this is said to occur most frequently as 
the result of inunction. Usually the eruption is evanescent, 
being followed by desquamation in two or three days ; but cases 
have been observed in which there has been a grave generalized 
dermatitis, with marked swelling of the face and extremities, 
excessive desquamation, subcutaneous infiltration, excoriation, 
fever, disturbance of the respiration, and prostration, resulting 
even in death. 

Temperature. — Mercury in itself has no effect on the body 
temperature, but in severe ptyalism and in the more serious 
cutaneous affections caused by it there is always more or less 



30 PHARMACOLOGY AND THERAPEUTICS. 

febrile reaction. In collapse resulting from poisoning by the 
drug the temperature may fall several degrees below the normal. 

Therapeutics of Mercury and its Salts. 
External. Antiseptic Action. — Mercurials, and especially the 
bichloride, are at the present time used very extensively for 
antiseptic purposes in surgery and midwifery. Of the numer- 
ous methods which have been proposed for disinfecting the 
hands, two, those of Welch and Fiirbringer (which is much 
simpler), are considered trustworthy. They are described as 
follows: Welch's method: (i) The hands and nails are thor- 
oughly cleansed with hot water and soap, the water to be as 
hot as can be borne, and the brush used to have been first 
sterilized with steam. This preliminary brushing should occupy 
from three to five minutes. (2) The hands are rinsed in 
clean, warm water. (3) They are next immersed for one or 
two minutes in a warm, saturated solution of potassium perman- 
ganate, and while in this solution they are thoroughly rubbed 
with a sterilized swab of absorbent cotton. (4) They are next 
placed in a warm, saturated solution of oxalic acid, and kept 
there until completely decolorized. (5) They are then 
thoroughly washed in clean, sterilized water or salt solution. 
(6) Finally, they are immersed for two minutes in 1 to 500 
corrosive sublimate solution, rinsed in water, and dried. Fiir- 
bringer's method: (1) Remove all dirt under and around the 
nails. (2) Brush nails and skin of hands thoroughly with soap 
and hot water. (3) Immerse in alcohol, 95 per cent., for not 
less than a minute, and before this evaporates (4) plunge the 
hands in 1 to 500 corrosive sublimate or 3 per cent, carbolic acid 
solution, and thoroughly wash them for at least a minute; after 
which the hands may be rinsed in warm water and dried. On 
account of the difficulty of thoroughly disinfecting the hands, 
however, many surgeons have now adopted the practice of wear- 
ing rubber gloves when operating, and such gloves are also 
often used by obstetricians. For washing the walls or 
floors of infected rooms and furniture, linen and other articles, 



MERCURY. 3 I 

and for soaking towels, lint, sponges, etc., used in operations, 
a corrosive sublimate solution of the strength of I to 1,000 is 
usually employed. The corrosive chloride cannot be used for 
disinfecting metallic instruments, as mercury becomes deposited 
upon them. The use of this salt for vaginal injections and 
otherwise in obstetrics is believed to have been one of the 
principal factors in the remarkable reduction of the death-rate 
which has in recent years been noted in lying-in hospitals. 

In preparing a surface of the body for operation the part is 
generally scrubbed with green soap and warm water, and, after 
being shaved, is cleansed with ether or alcohol. It is then 
irrigated with a I to 1,000 bichloride solution, but if the skin is 
at all broken a very much weaker one is employed. For a 
single washing of wounds or cavities the strength should not 
exceed i to 2,000, and weaker solutions are preferable. For 
continued irrigation it should not exceed 1 to 10,000, and even 
this strength has been known, when used in the peritoneal 
cavity, to give rise to toxic symptoms. Gauze washed in a 
weak bichloride solution is frequently used as a dressing after 
operations. In using the bichloride and other preparations of 
mercury as antiseptics it is often advisable to add about 5 parts 
of tartaric, citric or hydrochloric acid to 1 of the mercurial in 
the solution employed, in order to prevent its uniting with the 
albumin of the tissues. Otherwise an insoluble and useless 
mercury albuminate may be formed, and the antiseptic value of 
the fluid be destroyed. Bichloride solutions should as a rule 
be freshly prepared, but if it is necessary for any reason to keep 
them for some length of time, either sodium chloride or a weak 
acid should be added to prevent decomposition of the bichloride. 
Bichloride tablets, tinted blue for safety, which are made of 
such a strength that one dissolved in a pint of water makes a 
solution of 1 to 500, are extremely convenient for ready use. 
Mercuric biniodide (1 to 4,000 to 1 to 20,000) has been used to 
a small extent as an aniseptic, and in eye surgery is said to be 
preferred by some to the bichloride, on account of its being less 
irritating than the latter. The mixed mercury and zinc cyanide, 



$2 PHARMACOLOGY AND THERAPEUTICS. 

as suggested by Lister, is unirritating. It is said to have but 
slight germicidal value, but its inhibitory power is so great that 
a solution of I to 1,200 will permanently prevent putrefaction in 
animal fluids. Cyanide gauze may be made actively germicidal 
by impregnation with a solution of 1 to 4,000 of corrosive 
mercuric chloride. The following reaction may be used to 
determine whether the corrosive mercuric chloride with which 
gauze has been impregnated has partially changed into the 
mild chloride : If a black color appears upon application of 
lime water, calomel is present. 

Irritant Action. — The Unguentum Hydrargyri Iodidi Rubri, 
B. P. (mercuric iodide, 2; benzoated lard, 48), is employed as 
a dressing to indolent scrofulous and syphilitic ulcers. The acid 
solution of mercuric nitrate is of service in the treatment of 
warts, chancroids, syphilitic condylomata, mucous patches, and 
ulcers of the mouth, while citrine and red precipitate ointments, 
properly diluted, may often be applied with advantage to ulcers 
and sores, whether syphilitic or not, when a stimulating effect 
is desired. The application of solution of the nitrate is painful 
and may cause haemorrhage, and it should be used with caution 
on account of the danger of giving rise to sloughing. It is 
recommended that it should never be employed for venereal 
ulcers in full strength, and as a substitute for its application 
Ricord's method of treatment may be adopted. This consists 
of washing the sores or condylomata with solution of chlorin- 
ated soda, and, after drying with absorbent cotton, dusting calo-. 
mel, or equal parts of calomel and starch, over the surface. 
When a milder preparation is required, black wash (Lotio Hy- 
drargyri Nigra, B. P. — Calomel, 1; glycerin, 8; mucilage of 
tragacanth, 20; lime water, to 160) ; is also very commonly 
used. 

Antiparasitic Action. — Mercurial preparations are among our 
most valuable applications in external parasitic affections. For 
destroying lice upon the head white precipitate ointment, dilute 
citrine ointment, and corrosive sublimate, in the form of a wash, 
are all used, and the same agents, particularly the latter, are 



MERCURY. 33 

also efficient in such conditions as scabies, favus, ringworm, 
tinea sycosis, and pityriasis versicolor. The oleate of mercury 
is employed to some extent for the same purposes, but it should 
be considerably reduced in strength for most cases. The oleate 
diluted with oleic acid, with the addition of one-eighth part of 
ether, has been recommended by some. Unguentum Hydrargyri 
Oleatis B. P. (Oleate of mercury, i; benzoated lard, 3), may 
also be used. Caution should be exercised in not applying 
mercurials over too large an area, on account of the risk of 
the production of toxic effects through absorption. 

Cutaneous Affections. — A weak calomel ointment is often of 
service in itching affections, especially around the anus. The 
Unguentum Hydrargyri Subchloridi, B. P., contains 10 per cent, 
of calomel. In impetigo contagiosa and ecthyma such an oint- 
ment may be applied after separation of the crusts. Calomel 
ointments, as well as white precipitate ointment with the addi- 
tion of a little menthol and cocaine, are also beneficial in herpes, 
herpes zoster, seborrhcea, and eczema, especially of the genital 
organs. An ointment which is highly esteemed in many skin 
diseases is composed of equal parts of diluted mercuric nitrate, 
zinc oxide and lead acetate ointments. The B. P. Unguentum 
Hydrargyri Nitratis Dilutum consists of 20 per cent, mercuric 
nitrate ointment, with paraffin. For chronic psoriasis and 
eczema, especially of the hands and feet, an ointment composed 
of equal parts of mercuric nitrate ointment and lanolin, with a 
varying amount of oil of juniper, has been found efficient. 
Black wash and yellow wash (Lotio Hydrargyri Flava, B. P.: 
corrosive mercuric chloride, 1 ; lime water, 240) may also be 
used to allay the itching of such cutaneous affections as pruritus 
senilis and urticaria, if the disease is not too extensive in area. 
For the local treatment of variolous pustules and also of erysipe- 
las it has been recommended that the surface should be sprayed 
with a solution containing 1 gm. (15 gr.), each, of corrosive 
mercuric chloride and either citric or tartaric acid, 5 c.c. (80 ^l) 
of 90 per cent, alcohol, and a sufficient quantity of sulphuric 
ether to make 90 c.c. (3 fl. dr.). The following application has 

4 



34 PHARMACOLOGY AND THERAPEUTICS. 

also been found highly successful in erysipelas : Resorcinol (or 
naphthalene), 5; ichthyol, 5; mercurial ointment, 40; lanolin, 
50. When the skin is not too tender, it is advised that the 
proportion of ichthyol should be increased. After the affected 
parts have been anointed with this they are covered with 
oiled silk or other impermeable material, and then enveloped 
in a light dressing and bandaged. 

Diseases of the Eye and Ear. — In ophthalmic practice the 
ointment of yellow mercuric oxide, known as Pagenstecher's 
ointment or ophthalmic salve, is largely employed. Calomel is 
also used as a sedative application in conjunctivitis and other 
affections. Before applying calomel to the eye, however, it 
should first be ascertained whether the patient has had a course 
of iodine treatment, since, if this is the case, a caustic com- 
pound may be formed between the mercury and iodine which 
may set up violent inflammation of the conjunctiva and the 
lids, possibly resulting in almost complete loss of vision. 
Largely diluted citrine ointment is sometimes used in the place 
of Pagenstecher's ointment in the treatment of chronic bleph- 
aritis, tinea tarsi, and eczema. Favorable results have been 
reported from the subconjunctival injection of a small quan- 
tity (0.12 c.c. — 2 HI) of 1 to 1000 solution of mercuric bichlo- 
ride in iritis (both syphilitic and non-syphilitic), choroido- 
iritis, exudative choroiditis, central choroido-retinitis, and de- 
tachment of the retina. Mercuric cyanide has sometimes been 
employed instead of the bichloride. This method of treatment 
has also proved successful in some cases of sympathetic ophthal- 
mia, but appears to have failed in keratitis. It is stated to be 
not adapted to cases in which the stasis of the local circulation 
prevents, either wholly or in part, absorption of the injected 
fluid. In ear affections an ointment of yellow mercuric oxide, 
0.32-0.65 gm. (5 to 10 gr.) to 30 gm. (1 oz.) of lard or cold 
cream, is used to a considerable extent to subdue inflammatory 
action. 

Absorbent Action. — Oleate of mercury and the various mer- 
curial ointments are used to a considerable extent to reduce 



MERCURY. 35 

swellings and promote the absorption of subcutaneous effusions 
and the general products of inflammatory action. They are not, 
however, superior in efficiency to other agents for such pur- 
poses, and have the disadvantage of introducing the poison 
mercury into the system. While in some instances the con- 
stitutional effects of the latter may not be contra-indicated, in 
many others they may prove decidedly objectionable and even 
dangerous. The likelihood of the occurrence of such absorption 
and its possible consequences should always be borne in mind. 
Mercurial ointment, blue ointment, Scott's ointment (Unguen- 
tum Hydrargyri Compositum, B. P., which consists of mercurial 
ointment, 10; yellow wax, 6; olive oil, 6; and camphor 3), or 
the oleate in an ointment, may be applied in affections of the 
joints, orchitis and chronically enlarged glands. Chronic peri- 
tonitis has sometimes been treated with success by the use of a 
binder spread with one of these preparations or the Linimentum 
Hydrargyri, B. P., which consists of equal parts of mercurial 
ointment, solution of ammonia, and camphor liniment. The 
ointment of red mercuric iodide, somewhat diluted and applied 
before a hot fire or in the direct sunlight, is said, in numerous 
instances, to have speedily reduced goitre and enlarged spleen. 
Internal. Alimentary Canal. — One of the most important 
internal uses of mercury is as a purge, and the two preparations 
employed for this purpose are blue mass and calomel. In the 
condition commonly known as biliousness, which is character- 
ized by lassitude, headache, constipation, nausea, yellowish- 
coated tongue, yellow conjunctivse, and more or less " muddi- 
ness " of the skin, either of these drugs at night, followed by a 
hydragogue cathartic in the morning, will often completely 
relieve the symptoms, which are due, not to hepatic derange- 
ment, but to disorders resulting from the putrefactive changes 
in the gastro-intestinal tract which are responsible for the con- 
version of the green bile pigments into those of the faeces. 
The dark, greenish stools following the use of mercurials is 
explained by the abolition or lessening of these putrefactive 
changes. The principal action of the mercurials, it is believed, 



36 PHARMACOLOGY AND THERAPEUTICS. 

is exercised partly upon the glandular system of the gastro- 
intestinal tract, and partly upon the, bacteria of the region, 
which, after being destroyed by the antiseptic properties of 
the mercurial, are swept away by the succeeding purge. Blue 
mass is less certain and less energetic in its action than calo- 
mel. In conditions where there are loss of appetite, tympanites, 
jaundice and whitish or clay-colored stools, and which are 
believed to be due to a catarrhal state of the mucous membrane 
of the hepatic duct and of the intestine, mercurials have long 
been highly esteemed on account of their supposed cholagogue 
action. It is true that they are generally efficient in removing 
the symptoms, but it is in the manner just referred to, and it 
has been found that such salines as sodium phosphate, mag- 
nesium sulphate and Rochelle salt will often answer equally 
well. In conditions like the above and in others where there is 
constipation, instead of giving a single full dose of blue pill or 
calomel, the practice has now become quite commonly adopted 
of prescribing the latter in small doses, such as .016 to .006 gm. 
(y A to-j^gr.), thoroughly triturated with sugar of milk and 
repeated every hour until a movement is secured. Some physi- 
cians stop the calomel after four or five doses have been taken, 
and give a dose of bitter water or Rochelle salt the next morn- 
ing. Others give the calomel every fifteen minutes until six 
doses of .006 gm. (y 1 ^ gr.) have been taken, and four hours 
afterward, a saline. The efficiency of the calomel is believed 
by many to be increased by combining with each dose .13 gm. 
(2 gr.) of sodium bicarbonate. The action of repeated small 
doses of calomel has been found to be entirely satisfactory, 
while this plan of administration is much more comfortable for 
the patient than the use of large doses. Mercurials are usually 
well borne by infants and children. Gray powder (Hydrargy- 
rum cum Creta), in minute doses, has been advised for the sud- 
den vomiting immediately after the ingestion of food sometimes 
observed in children. In cholera infantum and in other diar- 
rhceal diseases, both acute and chronic, it may also often be 
used with good effect. In cases of diarrhoea due to the pres- 



MERCURY. 37 

ence of some irritant in the intestinal tract, one or two doses 
will not infrequently prove curative by removing the offending 
material. Gray powder is a very useful purgative for children, 
and also for adults when a very mild effect is desired. Its ac- 
tion does not, as a rule, cause any griping, which is sometimes 
quite marked in the case of calomel. On account of their anti- 
septic effects in the intestine, mercurials are given to a con- 
siderable extent, especially in Germany, in typhoid fever. Some 
physicians make it a practice to commence their treatment of 
this disease with calomel. Calomel has also been recommended 
in Asiatic cholera, but it cannot be said that the results from it 
have proved very satisfactory. Formerly large doses at con- 
siderable intervals were often employed, but at the present time, 
when its use is resorted to here, it is more commonly given in 
small doses, frequently repeated, and also combined with opium, 
chalk, piperine, etc. It is stated, however, that large doses 
(1.30 to 4 gm. ; 20 gr. to 1 dr.) sometimes appear to arrest 
vomiting when other means fail, though given in such amounts 
it is liable to produce excessive ptyalism when reaction sets in. 
Cardiac and Inflammatory Diseases. — In valvular disease of 
the heart with dropsy mercury sometimes proves of great ser- 
vice when combined with digitalis and squill, as in Guy's diuretic 
pill, which is composed as follows: Blue pill, powdered squill, 
and powdered digitalis, each, .06 gm. (1 gr.) ; extract of hyo- 
scyamus, .10 gm. (gr. 1^2). The drug is considered by many a 
very valuable antiphlogistic agent, provided that its use be 
restricted to the treatment of inflammatory action of a sthenic 
type. Some authorities believe it to be the best remedy in 
sthenic endocarditis, and useful also in myocarditis and peri- 
carditis. While mercuric bichloride is sometimes used instead 
of calomel in these affections, for the reason that it does not 
produce catharsis, it has not usually been found as efficacious 
as calomel. When the latter is given as an antiphlogistic, 
opium is commonly combined with it, not only to prevent its 
acting on the bowels, but also to relieve pain and irritation. In 
meningitis resulting from head injuries it has been recom- 



3 8 PHARMACOLOGY AND THERAPEUTICS. 

mended that a powder containing .015 gm. (% gr.) each of 
calomel and powdered opium should be given every hour for 
five or six hours, while at the same time an ice-bag is kept 
applied to the head. In the early stages of diphtheria and 
croup mercury is thought to exert distinct prophylactic power. 
It is generally given in the form of the bichloride, but some 
advocate, as preferable, the use of calomel, administered in 
small repeated doses in dry powders, believing that the good 
effect of the mercurial is at least in part due to its diffusion 
over the diseased surface, and the consequent antiseptic influ- 
ence thus produced. In both pneumonia and pleurisy large 
doses of calomel have been highly recommended by certain 
clinicians, but the weight of opinion is to the effect that mercury 
is of decidedly less value in parenchymatous inflammations, 
such as pneumonia and hepatitis, than in those of a serous, 
character, like pleurisy, pericarditis and peritonitis. It should 
be carefully borne in mind that it ought never to be given in 
asthenic inflammatory conditions, and that in employing it as 
an antiphlogistic it should be exhibited during the stage of 
exudation, and to facilitate the absorption of the newly organ- 
ized lymph. In the treatment of iritis the use of mercury has 
proved especially successful, and it is the common practice in 
this affection to push the remedy to the point of ptyalism when- 
ever the tendency towards the exudation of lymph is marked. 
Although the matter has never as yet been practically demon- 
strated, there is considerable ground for the belief that the 
drug has the effect of diminishing the fibrin in the blood, and 
as in inflammatory conditions the latter is known to be in- 
creased, it has been supposed that there is a certain antagonism 
between the processes of mercurialization and of inflammation. 
Before leaving this branch of the subject, however, the state- 
ment should be made that many modern authorities believe 
that mercury has little or no remedial influence in acute in- 
flammation, either in the serous membranes or elsewhere, and 
that as it is commonly combined with opium, whatever benefit 
is noted from such treatment in inflammatory affections is to 



MERCURY. 39 

be attributed to that drug. In iritis, in which the efficacy of 
mercurials is admitted by all, it is contended that the good 
result is due to the fact that this disease is almost universally of 
syphilitic origin. With the growth of this opinion in the pro- 
fession the antiphlogistic use of mercury has undoubtedly be- 
come much more restricted than formerly. The various forms 
of the drug are now very commonly administered in the form of 
triturates, made with sugar of milk, which contain about 10 
per cent, of the mercurial preparation. Thus minutely sub- 
divided, the remedy is found to be more readily absorbed. 

Syphilis. — Undoubtedly the most important of all the uses of 
mercury is in the treatment of syphilis. Whatever question 
there may be as to its special utility in other conditions, all are 
agreed as to its preeminent value in this disease. Like quinine 
in malarial fever, it is universally conceded to be a true specific, 
although its precise mode of action has not as yet been deter- 
mined. While some authorities have contended that its cura- 
tive influence is due simply to the general effects upon metab- 
olism, it seems altogether probable that this is attributable to a 
specific toxicity for the syphilitic virus, which, when the drug is 
adequately exhibited, finally results in the complete destruction 
of the latter. Some eminent syphilographers hold that the 
action of mercury is to clear away from the tissues the products 
of a specific inflammation, or at least to relieve tissues encum- 
bered with superfluous and obstructive material; but whether 
it develops a specific destructive action on the virus or not, the 
fact remains that mercury is employed in syphilis because 
experience has shown indisputably that it cures the disease. 
In order to secure the most satisfactory results it is requisite 
that its administration should be commenced at the earliest pos- 
sible moment and that it should be continued for a considerable 
period after all manifestations of the disorder have disappeared. 
Its value in syphilitic condylomata, ulcerations, etc., has already 
been referred to, but here its local application is not sufficient, 
and an internal mercurial course should be entered upon just as 
soon as the diagnosis is established. This should never be dis- 



40 PHARMACOLOGY AND THERAPEUTICS. 

continued under one year, and it is not infrequently necessary 
to maintain it, with periods of intermission, for several years. 
While all are agreed as to the efficacy of the drug in the first 
and second stages of syphilis, authorities differ as to its value 
in the third stage. As a rule, however, in the tertiary period 
it will be found that the best results can be obtained by the 
mixed treatment, as it is called, mercurials in combination with 
the iodides, particularly potassium iodide. In most cases in 
which the disease is recognized early and in which mercurial 
treatment is promptly instituted and faithfully carried out, no 
tertiary symptoms occur and the use of the iodide is entirely 
uncalled for. The dose of the remedy should be carefully regu- 
lated in accordance with the circumstances of each individual 
case. The effort should be made, it is recommended, to give 
the largest amount that can be borne without the production 
of gastric, buccal, or other irritation; in other words, to over- 
whelm the disease without detriment to the general condition 
of the patient. In the earlier stages the proto-salts of mercury 
(and particularly mercurous iodide, known as the yellow iodide) 
are considered the most serviceable; later in the disease, espe- 
cially when used in conjunction with potassium iodide, it is 
customary to employ the persalts, the bichloride and biniodide 
being the most esteemed. By some authorities the subcutaneous 
injection of mercurials is recommended, and under special cir- 
cumstances these agents are introduced into the system in 
various other ways than by the mouth. Mercury is as efficient 
in congenital syphilis as in the acquired form. 

Mercurol is a chemical combination of nucleinic acid and 
mercury, the former being obtained from yeast. It is sometimes 
employed in a 2 per cent, solution as an injection in gonorrhoea. 
This apparently destroys the gonococci, lessens the severity of 
the inflammation, and tends to prevent the development of com- 
plications. It does not entirely stop the discharge in some cases. 
It has also been used in the local treatment of other purulent 
conditions of a specific character, such as conjunctivitis, oph- 
thalmia neonatorum, and otitis media, and also as an antiseptic 
dressing. 



MERCURY. 41 

Sal Alembroth has useful antiseptic properties, and one of its 
advantages is that it does not combine so readily with albumin 
as corrosive mercuric chloride. For antiseptic purposes it is 
generally employed in the form of gauze (containing 1 per cent, 
of the sal alembroth) or wool (with 2 per cent.). Both are 
tinted with aniline blue, and as the latter is bleached by the 
discharge, it can readily be seen when it has soaked through. 
Sal alembroth, in doses of .02 gm. (-i gr.) to .60 c.c. (10 HI) of 
water, is considered a convenient and non-irritating prepara- 
tion for hypodermatic use in the treatment of syphilis. The 
precautions mentioned below (p. 44) should be observed. 

Mercuro-Zinc Cyanide. — As an antiseptic, this has been 
claimed to possess the advantages of being non-volatile, unirri- 
tating, insoluble in water, and soluble only in three thousand 
parts of blood serum; so that it is not easily washed off from 
gauze by discharges from wounds. Its germicidal value, how- 
ever, is stated to be very slight, though its inhibitory power is 
such that a one-twelve-hundredth solution will permanently pre- 
vent putrefaction in animal fluids. In order that mercuro-zinc 
cyanide gauze may be made actively germicidal it is recom- 
mended that it should be impregnated with a solution of one to 
four thousand of corrosive sublimate. The gauze and wool, as 
usually prepared, contain 3 per cent, of the salt each, and are 
both tinted pink. Mercuro-zinc cyanide has also been used 
in the form of an ointment. 

Hydrargyrol, which chemically considered is mercury para- 
phenyl thionate, has been proposed as a substitute for corrosive 
mercuric chloride in antiseptic surgery. It is claimed that, 
while precipitating alkaloids and basic toxins, it does not pre- 
cipitate albumin, and that a solution of 4 to 1000 is non-irritant 
to the mucous membrane or skin and is not injurious to surg- 
ical instruments. Its toxic properties, as shown by experiments 
upon animals, are decidedly less marked than those of corrosive 
sublimate. 

Colloid Mercury has been put forward as a reliable antisyphi- 
litic, the advantages of which consist in the facility with which 



42 PHARMACOLOGY AND THERAPEUTICS. 

it is absorbed, the fact that it does not irritate the skin, its slow 
and enduring action, and its comparatively slight virulence. It 
is said to be effective also, when incorporated in ointments and 
plasters, for the treatment of epididymitis, arthritis, lymphade- 
nitis, etc. Internally, in pill form, it has been recommended 
as a substitute for blue pill and mercurous protiodide, as well 
as for corrosive mercuric chloride. 

Modes of administration of mercurials. — (i) By the mouth. — A num- 
ber of the preparations of mercury most commonly used for internal 
administration have already been spoken of. Among those not as yet 
mentioned is mercurous tannate, the dose of which is .06 to .12 gm. (1 
to 2 gr.) given in a tablet triturate or pill. It is used to a considerable 
extent in the treatment of syphilis, and is well thought of by many. It 
is asserted that it passes unchanged through the stomach, but is rapidly 
absorbed in the small intestine, and that it does not irritate the alimen- 
tary canal. The Liquor Hydrargyri Perchloridi, B. P. (corrosive mer- 
curic chloride, 1 ; ammonium chloride, 1 ; water, 1000), is a favorite 
preparation, and is frequently combined with potassium iodide in ter- 
tiary syphilis. The usual dose is 4 to 8 c.c. (1 to 2 fl. dr.). When 
used with potassium iodide, there is formed mercuric iodide, which is 
kept in solution by the excess of the potassium iodide. Mercurous 
iodide should never be given at the same time as potassium iodide, as 
the latter immediately converts it into red mercuric iodide and metallic 
mercury. Gray powder, as has been mentioned, is much used in the 
intestinal disorders of children. It is also the most generally satisfac- 
tory preparation for internal administration in syphilis of early life. 
The ordinary dose is .03 to .06 gm. (H to 1 gr.), which should be given 
frequently enough to bring the system under the influence of the drug 
without affecting the bowels. By some high authorities it is consid- 
ered the best preparation for continued use in syphilitic adults, as well 
as children. Mercuric carbolate has been found quite efficient. It is 
readily absorbed and it is said that it may be given for a long time 
without producing ptyalism. For syphilitic ulcerations of the mouth a 
very good wash may be made of corrosive mercuric chloride, .24 gm. 
(4 gr.), in 30.0 c.c. (10 fl. oz.) of water, to which is added 4 c.c. (1 fl. 
dr.) of diluted hydrochloric acid and a little glycerin. In syphilitic 
ulceration of the tongue troches of liquorice, each containing .003 gm. 
(to £*".) of the bichloride, are sometimes employed. Allowed to dissolve 
in the mouth, they produce a constitutional as well as a local effect. 
Mercurials are not well borne by patients suffering from Bright's dis- 



MERCURY. 43 

ease, in whom ptyalism is more readily induced than in others, nor in 
gouty or scrofulous subjects. In the latter, mercurialization may give 
rise to very serious results, and where there is a gouty tendency neural- 
gia is often caused by small doses. 

(2) By the rectum. — By the use of suppositories patients can be 
brought very rapidly under the influence of the drug, and occasionally 
this method will be found of service. Each suppository may contain .30 
gm. (5 gr.) of mercurial ointment. 

(3) Endermatically. — Mercurials, externally applied, produce a gen- 
eral, as well as a local, effect, on account of their ready absorption. 
Reference has already been made to the use of various lotions in sores, 
ulcers and syphilitic condylomata, and the preparations in powder, par- 
ticularly calomel, are often dusted on the surface in these conditions. 
Mercury is now never administered by the strict endermatic method, 
which consists of removing the cuticle by a blister or other means and 
applying the medicinal agent directly to the true skin, as it is a pain- 
ful procedure and the systemic effects of the drug may be much more 
satisfactorily obtained in other ways. 

(4) By inunction. — Mercury applied by inunction is quickly absorbed, 
and this method has a well-recognized position in the treatment of 
syphilis. Among the other conditions in which it has been found of 
service is gonorrheal rheumatism. It is used to a considerable extent 
in the treatment of infants and young children affected with congenital 
or acquired syphilis, and also in the case of adults when it is desired 
to bring the system rapidly under the influence of the drug, and at the 
same time to avoid disturbance of the digestive apparatus. Either mer- 
curial ointment or the oleate of mercury may be used for this purpose, 
and the latter possesses the advantage of not staining the clothing. It 
is customary to rub a piece about the size of a marble upon the inner 
side of the thigh or arm once or twice a day, and it is advised to change 
the application from place to place on account of the local irritation 
sometimes caused by the mercury. A hot bath previous to each inunc- 
tion no doubt assists absorption. If the patient does not apply the mer- 
curial himself, it is advisable that the person doing so, in order to avoid 
accidental salivation, should be protected by a bladder or a rubber glove, 
and should also wash his hands thoroughly with soap after each appli- 
cation. Another plan is to rub the ointment on the soles of the feet, 
so that the exercise of walking may promote absorption of the remedy. 
In the case of children it is often smeared upon the abdomen, after 
which the latter is covered with a flannel binder. It should be noted 
that in the eighth revision of the U. S. Pharmacopoeia there has been 



44 PHARMACOLOGY AND THERAPEUTICS. 

introduced an Unguentum Hydrargyri Dilutum (mercurial ointment, 
670; petrolatum, 330), with the name Blue Ointment, a designation 
which formerly was commonly applied to the official Unguentum 
Hydrargyri (mercurial ointment). At the present day it is not re- 
garded as necessary that mercurials should be rubbed into the skin 
with friction, as it has been found that the mere fact of spreading 
them upon the surface of the body and leaving them in contact with 
the skin is sufficient to secure the physiological effects of the drug. It 
is asserted that in Paris syphilis has been successfully treated by the 
application over the spleen of a plaster composed of calomel, 20, castor 
oil, 6, and diachylon plaster, 60 parts ; ptyalism being prevented by the 
alternate use and disuse of the plaster for periods of eight days at a 
time. Another method of external application is to paint the patient's 
back, after bathing, with a solution of gutta percha in chloroform, to 
which has been added a quarter of its weight of calomel. After the 
chloroform has evaporated the skin remains coated with a mercurial 
varnish. Calomel soap, made by triturating pure olive oil soap with 
calomel in the proportion of one to two or three, has been used by 
some as a substitute for mercurial ointment. It is cleanly and non-irri- 
tating to the skin, and its use is said to constitute an efficient method 
of mercurialization. A rare complication which has been attributed to 
the effect of mercury on the system is polyneuritis, and it is said that 
this has especially been noted after the very free use of mercurial in- 
unctions. 

(5) Hypodermatically. — This method is now practiced to a consid- 
erable extent in special cases, and is a cleanly, rapid and efficient way 
of producing the constitutional effects of mercury without gastrointes- 
tinal irritation. It is said to be more successful than any other in pre- 
venting relapses in syphilis. The corrosive chloride is usually selected 
for this purpose, and if properly employed seldom produces local irrita- 
tion, although instances have been recorded in which it gave rise to 
abscesses and sloughing. Care should be taken that the syringe and 
needle are aseptic, and it is recommended that the needle should be 
deeply inserted, preferably into the muscles on the outer side of the 
gluteal region. If much pain is caused by the injections, a piece of ice 
may be held over the spot both before and after the insertion of the 
needle, or cocaine may be injected immediately before the mercurial. 
But one injection a day should be given, and it is advised that this 
should be at bedtime. A solution of .06 gm. (1 gr.) of corrosive chlo- 
ride in 8 c.c. (2 fl. dr.) of distilled water may be employed, and of this 
.60 c.c. (10 m.) may be administered at first, and the dose gradually 



MERCURY. 45 

increased until 3 c.c. (50 m.) is reached, or until constitutional effects 
are observed. As soon as this is the case the dose should be reduced 
to the minimum. In some old cases of syphilis, in emaciated, broken- 
down subjects, it is recommended, instead of using daily injections in 
small doses, to give as much as .015 to .02 gra. (% to )/$ gr.) two or 
three times a week. A large number of mercurial preparations have 
been proposed for subcutaneous injection, but none of them appears to 
have any distinct advantage over corrosive sublimate ; while most of 
them have been found considerably more dangerous. Among them may 
be mentioned mercuric formamidate, which is neutral in reaction, readily 
combines with water, does not coagulate albumin, and is not precipitated 
by alkalies. While generally well tolerated, the formamidate injections 
have proved very much less reliable than those of the bichloride, and 
relapses are stated to have been extraordinarily common after their use. 
The subcutaneous employment of sal alembroth has already been referred 
to. Gray oil, which consists of mercury, lanolin and olive oil, is more 
or less used for subcutaneous injection, and by some is preferred to 
any other preparation for this purpose. Some clinicians have reported 
very favorable results from the use of hypodermatic injections in 
infantile syphilis, particularly, of corrosive sublimate and of gray oil. 
A form in which the bichloride is said to be less liable to produce pain 
or irritation than in simple watery solution is the glutin-peptone sub- 
limate, which contains 25 per cent, of the drug. In using mercurials 
hypodermatically points of importance are to see that the part is well 
rubbed immediately after the injection, so as to dispel the local accumu- 
lation of fluid, and that injections are not given on successive days at 
spots near to each other. One of the evil effects which are liable to 
be produced by the continued and free administration of mercurials is 
nephritis, and it has been found that the safest method of mercurializa- 
tion, so far as the kidneys are concerned, is by the hypodermatic em- 
ployment of the corrosive chloride, while the most dangerous is prob- 
ably the use of inunctions. Very deep intra-muscular injections are 
advocated by some authorities as not only painless, but productive of 
the best practical results. A Pravaz syringe-full of a preparation con- 
sisting of purified mercury, 20 ; lanolin, 5 ; vaselin, 35, is injected deep 
into the tissues of the back once in fifteen or twenty days. 

(6) Intravenous injection. — This method has been recommended by 
some as having certain advantages, one of them being stated to be more 
rapid absorption and therapeutic effect than by any other. It possesses 
certain disadvantages also, and the opinion has been expressed by good 
authorities that it should not be preferably used in cases, of syphilig 



46 PHARMACOLOGY AND THERAPEUTICS. 

easily amenable to ordinary treatment or in the early stages of the dis- 
ease, though it is of special value in obstinate cases resisting other 
treatment ; also in advanced cases of organic syphilis, or when immedi- 
ate relief is urgently called for by reason of pain, encroachments on a 
vital part, or rapid destruction of tissue. Cases of cerebral syphilis 
which had proved unamenable to ordinary treatment have been reported 
in which this method was attended with excellent results. The injec- 
tion, which was practiced daily, was usually made into the superficial 
veins in front of the elbow, and the dose of corrosive sublimate (the 
preparation employed) was gradually increased from .0004 gm. ( T y2 S r -) 
to .0027 gm. ( Jj gr.). Mercuric cyanide has also been used for intra- 
venous injection, and is preferred by some to the bichloride. One c.c. 
(15 m.) of a 10 per cent, solution, made with distilled water, is injected 
into a vein at the bend of the elbow, after a rubber tube has been tied 
around the arm above. Before the injection is made the needle is first 
inserted and then unscrewed, to note by the flow of blood that it has 
entered the vessel. It is claimed that neither thrombosis nor embolism 
has been observed in consequence of the procedure. By some writers, 
however, intravenous injections are considered so dangerous as to ren- 
der this method unjustifiable. Certainly neither intravenous nor hypo- 
dermatic injection should be resorted to in the ordinary routine treat- 
ment of syphilis. 

(7) Fumigation. — Mercurial fumigations often prove highly service- 
able in syphilis, and by some the most satisfactory method of treating 
the secondary eruptions upon the skin is believed to be by fumigation 
with calomel two or three times a week, accompanied by the administra- 
tion of the iodides internally, with tonics whenever necessary, and proper 
attention to the general health. The black oxide and the red sulphide, 
neither of which is now official, are also used for fumigations. The 
method is as follows : The patient, having taken a warm bath to prepare 
the skin for absorption, sits upon a chair and is covered with a large 
blanket or rubber cloth (a mackintosh cloak serves very well for the 
purpose), which is gathered in closely about his neck and extends down 
to the floor all around. The mercurial preparation, say 1.20 gm. (20 
gr.) of calomel, is placed in a porcelain or metallic dish, over a spirit 
lamp, underneath the chair. The most satisfactory apparatus is one in 
which the alcohol flame sublimes the calomel and boils water at the 
same time, and is made of sheet iron or tin plate. The centre, on which 
the mercurial is placed, is flattened, and around this is a circular depres- 
sion, which is about one-third filled with water. The heat produced gen- 
erally causes profuse sweating, and the mercury, after having become 



MERCURY. 47 

volatilized, is deposited upon the cutaneous surface. In about twenty 
minutes the lamp is extinguished, and the patient is then wrapped in 
blankets and put to bed with the mercury still adhering to his skin. 

(8) Inhalation. — Inhalation is occasionally used independently of 
fumigation, and not infrequently in connection with the latter, the mer- 
curial preparation being volatilized in the same manner. When it is 
desired to practice it in conjunction with fumigation the patient is di- 
rected to inhale for two or three separate minutes during the bath. In 
doing this he should not put his head under the cloak or blanket, but 
simply allow some of the vapor to escape from the, upper part, and 
breathe it mixed with a large proportion of common air. When inhala- 
tions are employed separately the amount of calomel used should not 
exceed .260 to .325 gm. (4 to 5 gr.), and the face should be held six 
or eight inches from the receptacle. Unless a local action on the buc- 
cal mucous membrane is desired, it is advisable that the mouth should 
be rinsed out with potassium chlorate solution in order to prevent the 
occurrence of mercurial stomatitis. 

(9) Baths of 12 gm. (3 dr.) of corrosive mercuric chloride, with 4 
c.c. (1 fl. dr.) of hydrochloric acid, or of 4 to 8 gm. (1 to 2 dr.) of 
the chloride, with twice as much common salt, to each bath, were for- 
merly used to some extent for syphilitic subjects with skin-lesions, but 
are now very rarely resorted to. Remarkably successful results, how- 
ever, have recently been reported in the treatment of small-pox, even 
of the most serious type, by means of corrosive sublimate baths. Twice 
a day a bath-tub was brought to the patient's bedside and filled with 
a warm (40.5° C— 105° F.) solution of the bichloride (1 to 10,000), 
when the patient was immersed, except the head and shoulders, for ten 
or twelve minutes, the nurse gently rubbing the entire body with a 
soft cloth during the bath. 

TOXICOLOGY. 
Acute poisoning is not infrequently met with, and corrosive subli- 
mate and white precipitate are the preparations usually taken. Corro- 
sive mercuric chloride in toxic dose at once produces a metallic taste 
in the mouth and intense pain in the throat and stomach, quickly fol- 
lowed by severe retching and vomiting. Soon there is hsematemesis, 
and violent purging also sets in, the stools at first being serous and 
afterwards bloody in character. The urine becomes very scanty, and 
contains albumin, blood and casts. The pulse becomes weak and rapid, 
the temperature is lowered, and there is marked depression of all the 
vital powers, often ending fatally in a short time. After death the 



48 PHARMACOLOGY AND THERAPEUTICS. 

principal lesions customarily found are marked membranous colitis and 
parenchymatous and hemorrhagic nephritis, with widespread degenera- 
tion of the renal epithelium and, less commonly, a peculiar deposit of 
calcium phosphate. Treatment. — In case of acute poisoning the stomach 
should be evacuated by means of the stomach-tube, if possible. If this 
is not available, vomiting should be promoted by mustard and luke-warm 
water or apomorphine, or by irritation of the fauces. Albumin, in the 
form of the white of an egg (one being sufficient for .24 gm. — 4 gr. — 
of the corrosive chloride, the albuminate redissolving in an excess), 
milk and flour are useful. Tannic acid may also be given to protect 
the mucous membrarfe. 

Chronic Poisoning. — Except in workers in mercury, this is now much 
more rarely observed than formerly, when it was the common practice 
to give large doses of the drug. The characteristic salivation, stomati- 
tis, and other effects of mercurialization have already been described. 
Occasionally metabolism was so profoundly affected that the resulting 
cachexia ended in death. The tremor frequently seen in those who 
work in the metal and inhale the vapor resembles paralysis agitans, 
and the muscular weakness has been designated " mercurial palsy." A 
low grade but obstinate inflammation of the tongue or the lips, which 
proceeds to ulceration, sometimes extends, as gangrene, to the cheeks 
and produces frightful deformity of the face. Treatment. — As in other 
chronic metal poisoning, the object of the treatment should be to pro- 
mote elimination by all possible channels. Sulphur baths and ordinary 
hot baths are of service. Diuretics may be given to assist the kidneys 
in carrying off the mercury, and the drinking of as much water as can 
be conveniently borne should be enjoined. The bowels should be kept 
free, but if diarrhoea is present it may call for treatment by opiates or 
other remedies. Opium is also sometimes required for the relief of 
pain, and the other symptoms should be treated on general principles. 
It is commonly believed that potassium and sodium iodide have some 
effect in causing the elimination of the metal, and while this claim has 
been disputed by some, it has never been disproved. Care should be 
taken, however, that the doses are not too large, since attention has 
been called to the fact that the combination of iodine with mercury in 
the tissues produces a soluble salt which is very active and which may 
secondarily cause mercurial intoxication of the system. Belladonna is 
sometimes required to diminish the excessive activity of the salivary 
glands, and in all cases a potassium chlorate solution is useful as a 
mouth-wash in the treatment of salivation and stomatitis. Incidentally 
it may be remarked that it is the prevalent opinion that the free use 



FORMALDEHYDE. 49 

of such a mouth-wash, together with frequent and careful brushing of 
the teeth, is of material service in warding off ptyalism during the con- 
tinued administration of mercurials. Tincture of myrrh is frequently 
added to it, and tannic acid solution is also sometimes employed as a 
mouth-wash. Careful attention should always be paid to hygiene, and 
the general cachexia be combated by the most nutritious food, and 
such tonic or other remedies as may be called for. In establishments 
where mercury is used in the arts the same prophylaxis as in the case 
of lead is recommended. 

FORMALDEHYDE. 

FORMALDEHYDUM.— Formaldehyde. (Not official.) 

Preparation. 
Liquor Formaldehydi. — Solution of Formaldehyde. (For- 
malin. Formol.) 

Unofficial Preparations. 
Amyloformum. — Amyloform. 
Dextroformum. — Dextroform. 
Glutoformum. — Glutoform. (Glutol.) 
Glycoformalinum. — Glycoformalin. 
Faraformum. — Paraform. (Paraformaldehyde.) 

Action of Formaldehyde. 
Formaldehyde is regarded as equal in germicidal power to 
corrosive mercuric chloride, while, on account of its volatility, 
which enables it to diffuse much more rapidly, it can be used 
for purposes to which the latter is not adapted. At the same 
time, it is only slightly poisonous to the higher animals. When 
the vapor is inhaled, its most characteristic effect is marked 
irritation of the respiratory mucous membrane, causing bron- 
chial catarrh and a prickling and burning sensation in the 
nose and throat. Even when present in the atmosphere in very 
minute amount it gives rise to violent irritation of the air-pas- 
sages. It also excites increased secretion from the salivary and 
lachrymal glands. The powerful action of formaldehyde on 

5 



50 PHARMACOLOGY AND THERAPEUTICS. 

microbes and on mucous membranes has been attributed to its 
combining with some amide group in the proteids. Egg albumin 
and serum to which formaldehyde solution has been added is 
not, it is stated, precipitated by heat and is less easily digested by 
ferments, while casein so treated is not coagulated by the rennet 
ferment. The urine of animals to which it is given, even in 
moderate quantities, is found to be incapable of putrefaction. 
Experimental research has shown that a i per cent, aqueous 
solution will destroy all pathogenic spores within an hour. 
The drug has also a very powerful influence on various forms 
of organic matter, one part in four thousand completely decolor- 
izing wine, precipitating the extractive and coloring matters. 
The efficiency of urotropin, now so much used as a genito-urin- 
ary antiseptic, is thought to be due to the liberation of formal- 
dehyde from it. The penetrating power of the gas has been 
found to depend largely upon conditions of moisture, but under 
favorable circumstances is very considerable. When the watery 
solution is swallowed by animals its first effect is the production 
of nausea and vomiting. The blood-pressure is increased at 
first and the cardiac rhythm is retarded, as the result, it would 
appear, of stimulation, direct or indirect, of the medullary 
centres. As the poisoning progresses, narcosis and coma are 
produced, and in rabbits convulsions and opisthotonos. In 
dogs the respiration is very markedly quickened a considerable 
time before death. It has been shown that a portion at least 
of the formaldehyde which is absorbed passes through the 
tissues unchanged and is excreted in the urine, and it is thought 
not unlikely that the whole of it may do so. Some observers 
declare that it is a blood poison, causing alteration in the form 
of the cells and leading to the production of hsematin, and 
accordingly believe it probable that this effect is the chief 
factor in the intoxication caused by it. The fact has been 
noted that when administered hypodermatically formaldehyde 
produces less severe symptoms than when taken by the mouth, 
and this would seem to indicate that the effects caused by it 
are largely the result of its local action. So far as known, no 



FORMALDEHYDE. 5 1 

case has occurred in which it has caused in the human subject 
symptoms other than those of local irritation. One case has 
been reported in which a man took several ounces of formalin, 
by mistake, and recovered from its effects in three days, and 
another in which 30 c.c. (1 fl. oz.) was swallowed, and the 
patient recovered in a week. Externally applied, formaldehyde 
has the effect of hardening the skin. 

Therapeutics of Formaldehyde. 
The great practical value of formaldehyde as an antiseptic, 
disinfectant, deodorizer and germicide is now universally ac- 
knowledged, and the literature on the subject has become very 
voluminous. In the report of a series of careful experiments 
made under the supervision of the Health Department of New 
York City the following were among the conclusions reached: 
Formaldehyde gas is the best disinfectant at present known for 
the disinfection of infected dwellings. It is inferior in pene- 
trative power to steam and dry heat at 230 F., but for the 
disinfection of fine wearing apparel, furs, leather, upholstering, 
books and the like, which are injured by great heat, it is better 
adapted than any other disinfectant. It is superior to sulphur 
dioxide as a disinfectant for dwellings because (1) it is more 
efficient and rapid in its action; (2) it is less injurious in its 
effects on household goods; (3) it is less toxic to the higher 
forms of animal life; (4) when supplied from a generator 
placed outside the room and watched by an attendant, there is 
less danger of fire. It is claimed that by the addition of 10 per 
cent, of glycerin to the solution of formaldehyde the polymeriza- 
tion of the latter by heat is prevented, and hence that the so- 
called gly co formalin (consisting of formaldehyde, 30 parts, 
glycerin, 10 parts, and water, 60 parts), is superior for disin- 
fecting purposes to the ordinary aqueous solution. This pre- 
paration has been used to a considerable extent and appears to 
be very efficient, but has certain disadvantages, two of which 
are the sticky condition many articles are found in after its 
use, from a coating of glycerin, and the persistency of the odor 



52 PHARMACOLOGY AND THERAPEUTICS. 

left by it. Although its irritant action is objectionable, and 
the pain caused by the application of even a weak solution to 
ulcerated surfaces is very considerable, formaldehyde has been 
employed to quite a large extent in surgery, particularly in in- 
fected wounds, tubercular ulcers and abscesses, and infectious 
inflammations of the mucous membranes. The pain, it is found, 
can be obviated by the previous application of cocaine used in 
glycerin (i to 4 per cent.) ; also, it does not cause so much pain 
when applied to a mucous surface. A one per cent, solution of 
formaldehyde is often efficient, but by some it is thought some- 
times better to apply a rather strong solution once or twice than 
a weaker one more frequently. Among the affections in which 
this agent has been found useful may be mentioned parasitic 
stomatitis, ozsena, atrophic rhinitis, blepharitis, mucopurulent 
and follicular conjunctivitis, septic abrasions or ulcerations of 
the cornea (solutions of 1 part of formalin in 200 to 3000), the 
packing and drainage of pus cavities and sinuses, etc., in the 
place of iodoform gauze, tuberculous joints (by injection), 
puerperal sepsis (by packing the vagina), and lacerations of the 
perineum or cervix uteri. In the form of inhalations or sprays 
it has been employed in pertussis, bronchitis, influenza, diph- 
theria, the angina of scarlet fever, and pulmonary tuberculosis. 
In dermatology also it has been used to a considerable extent, 
being found beneficial in lupus, psoriasis, acne rosacea (by 
intradermal injection), in axillary and palmar hyperidrosis, and 
in sweating of the feet. It is reported to be of service in the 
treatment of the night sweats of phthisis, the skin being tanned 
with an application of a solution made according to the follow- 
ing formula: Formalin, 50 gm. (i£4 oz J Absolute Alcohol, 
50 gm. (i^4 oz.). This solution is applied to different parts 
of the body alternately, a protecting covering being employed 
over the part painted. The sweating is stated to be arrested 
almost immediately, and that part of the body keeps free from it 
for from five days to a month ; after which the treatment is re- 
peated. At the present time formaldehyde is used to a con- 
siderable extent in dentistry, as well as in veterinary practice. 



CHLORINE. 53 

Injections of its solution have proved remarkably successful in 
bovine anthrax. One of the useful applications of formalde- 
hyde is in the preservation of human bodies and of anatomical 
and pathological specimens. It is also largely employed as a 
fixing agent in histological work. For Urotropin (hexamethyl- 
enamine), which is obtained by the action of ammonia on 
formaldehyde, see Division VI., page 509. 

Paraform, the polymeric form of formaldehyde, which is a 
colorless, crystalline powder, insoluble in water, and gives off 
formaldehyde gas when slowly heated, is sometimes employed 
for disinfecting purposes. It is stated that instruments may be 
absolutely disinfected in fifteen minutes by the evaporation 
by means of heat of .30 gm. (5 gr.) of paraform in a chamber 
one cubic foot square. A 5 per cent, solution of paraform has 
been highly recommended as a caustic agent for the treatment 
of cutaneous growths of various kinds, such as warts and the 
like. 

G-lutol is a combination of formaldehyde and gelatin which is 
employed as an antiseptic powder. Drying on the surfaces of 
wounds or ulcers, it seals them and renders them sterile, and 
it is said to be especially efficacious in burns. Other antiseptic 
dressings are Amyloform and Dextroform, compounds of 
formaldehyde with starch and dextrin respectively. 

CHLORINE. 

CHLORUM.— Chlorine. (Not official.) 

Preparations. 

1. Calx Chlorinata (Calx Chlorata, U. S. P., 1890). — Chlorin- 
ated Lime. Chlorinated Calcium Oxide. (Bleaching Powder.) 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

2. Liquor Chlori Compositus (Replacing Aqua Chlori, U. 
S. P., 1890). — Compound Solution of Chlorine. Chlorine Water. 
Dose, 4 c.c.; 1 fl. dr. 

3. Liquor Sodae Chlorinatae (Liquor Sodae Chloratse, U. S. 
P., 1890). — Solution of Chlorinated Soda. (Labarraque's Solu- 
tion.) Dose, 1 c.c; 15 n\. 



54 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Electrozonum. — Electrozone. 

Action of Chlorine. 

External. — Chlorine gas, which is soluble in water in the 
proportion of two volumes to one, is greenish in color and has 
a penetrating and peculiar odor. It is intensely irritating to 
mucous membranes, and air containing even a small proportion 
of it affects the eyes, nose, fauces, larynx, bronchi and lungs. 
It is also a fact that it acts more energetically upon the deeper 
than upon the upper respiratory passages, so that an amount of 
the gas which gives rise to comparatively little irritation of the 
nose and pharynx may excite bronchitis and pulmonary conges- 
tion and haemorrhage. It has been found that while one volume 
of chlorine vapor in one million parts of air causes a certain 
amount of irritation, ten volumes in the same quantity of air, 
if inhaled for some time, will induce such serious effects as 
severe bronchitis and haemorrhage and inflammation of the 
lungs. Applied to the cutaneous surface, chlorine water pro- 
duces heat and redness, and, if the gas is prevented from escap- 
ing, will give rise to vesication. The germicidal action of chlo- 
rine is very pronounced, and in the presence of moisture it is 
one of the most powerful of disinfectants and deodorizers. 

Internal. — Chlorine has a marked affinity for hydrogen, and 
as a result of its combining with the hydrogen of water, nascent 
oxygen is set free and acts on the tissues. When taken inter- 
nally, chlorine is largely converted into hydrochloric acid, 
which afterwards becomes changed to chlorides during the 
process of absorption. A portion of it, however, it is thought, 
may form proteid compounds in the body. The claim that it 
is excreted in the free state in the urine is now held to be 
unfounded, as well as the statement that free chlorine has been 
recognized in the brain after death from its inhalation. It is 
poisonous chiefly by its local action. Except in small doses, 
chlorine water causes corrosive and intense inflammation of 
the mouth, throat and stomach, with the production of collapse. 



CHLORINE. 55 

After fatal poisoning from the inhalation of the gas, however, 
the gastric mucous membrane is found to remain unaffected. 
Apart from its local action, chlorine is said to have a narcotic 
effect upon the brain, and this has been attributed to the action 
of the proteid compounds mentioned. 

Therapeutics of Chlorine. 

External. — As a disinfectant chlorine has the disadvantage 
of injuring colored fabrics and wearing apparel. It may also 
cause inconvenient or even dangerous symptoms in persons 
using it, unless handled with great caution. It is regarded as 
inferior to sulphurous acid anhydride, and still more so to 
formaldehyde, not from its being weaker in action, but be- 
cause it is more difficult to apply in sufficient quantity. The 
room to be disinfected by it should be hermetically sealed, after 
the removal or protection of all metals and of fabrics likely to 
be injured or bleached. The gas can be generated from com- 
mon salt, 18; manganese dioxide, 15; and sulphuric acid, 45; 
in iced water, 21 parts by weight. As it is heavier than atmo- 
spheric air, the vessel should be placed on a high shelf, in 
order that the chlorine may be diffused throughout the room. 
For chlorine disinfection of rooms chlorinated lime, with the 
addition of acid in excess, is used by many. To disinfect hands, 
moistened chlorinated lime is spread over the hands, next a 
large crystal of washing soda is held in the hands, and they 
are washed, with rubbing, under water until a cooling sensation 
is experienced. The best disinfectant for excreta is fresh chlo- 
rinated lime, i; dissolved in water, 16. 960 c.c. (one quart) 
is placed in the receptacle into which the dejecta are received, 
and left one hour. It may also be used with good effect in 
drains, sinks, closets, urinals, etc. 

When exposed in the sick room, chlorinated lime acts 
rather as a deodorizer than as a disinfectant. The chlo- 
rinated preparations, in dilute solution, are very useful for 
destroying fetor in scarlet fever, diphtheria, aphtha? and gan- 
grene, and also in gangrenous wounds, sloughing ulcers, foul 



56 PHARMACOLOGY AND THERAPEUTICS. 

discharges, etc. The preparation known as electrozone, which 
consists of sea-water the alkaline chlorides of which have been 
converted into hypochlorites by electrolysis, is said to have 
about the same antiseptic strength as Liquor Sodae Chlorinatae. 
Chlorinated oil (olive oil saturated with chlorine) has been 
found a very efficient remedy in scabies. Chlorine water is 
sometimes used as an antiseptic in eye operations and diseases. 
A wash consisting of strong hydrochloric acid, .30 c.c. (5 Al) ; 
potassium chlorate, .60 gm. (10 gr.) ; water, 30 c.c. (1 fl. oz.), 
which gives off free chlorine, is serviceable for syringing the 
nose and fauces in scarlet fever, and a combination of the 
tincture of ferric chloride with potassium chlorate, in which 
some free chlorine is also evolved, constitutes an excellent 
antiseptic gargle. A strong solution of chlorinated soda makes 
a useful application for the bites of snakes and insects, and in 
Australia chlorinated lime, freshly prepared, is used in solu- 
tions of varying strength by hypodermatic injection as an 
antidote to serpent venom; the remedy being inserted into 
several points about the wound. 

Internal. — Chlorine water, in weak solution, is somewhat 
stimulant and tonic to the stomach. It has been successfully 
used, well diluted, in the diarrhcea of typhoid fever, particularly 
in markedly se'ptic patients. After the administration of doses 
of 4 c.c. (1 fl. dr.) every hour the temperature falls, the intellect 
brightens, the tongue clears, and betterment goes on to recovery 
in many apparently hopeless cases. This remedy was formerly 
considered of service in chronic affections of the liver, but 
is seldom used now for the purpose of acting on this organ. 

TOXICOLOGY. 

In poisoning with chlorine taken by the mouth alkalies should be 
given to neutralize the acid formed, and albumin, in the form of eggs, 
etc., is also of service. Narcotics may be called for to allay pain. In 
poisoning by inhalation, steam may be inhaled to diminish the irritation. 
Ammoniacal gas may also be given for the purpose of forming am- 
monium chloride, but it should be remembered that the ammonia is 
Itself irritant. 



PHENOL. 57 

PHENOL. 

1. PHENOL (Acidum Carbolicum, U. S. P., 1890).— Phenol. (Car- 
bolic Acid.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Glyceritum Phenolis. — Glycerite of Phenol. Dose, 0.3 c.c; 
5 Til. 

2. TJnguentum Phenolis. — Ointment of Phenol. 

2. PHENOL LIQUEFACTUM.— Liquefied Phenol. Dose, 0.05 c.c.; 

1 Til. 

3. CRESOL.— Cresol. (Tricresol.) Dose, 0.05 C.C.; 1 TT\.. 

Preparation. 
Liquor Cresolis Compositus. — Compound Solution of Cresol. 

Unofficial Preparations. 
Chlorophenol. — Chlorophenol. 
Phenosalylum. — Phenosalyl. 

Action of Phenol. 
External. — Phenol is an antizymotic of considerable energy, 
and, while not so powerful as some other agents of this class, at 
times constitutes a useful antiseptic and disinfectant. In suf- 
ficient strength it is poisonous to all varieties of protoplasm, 
but, like other antiseptics, it is much less toxic to microbes than 
to the protozoa and other simple forms of life. Again, it af- 
fects some species of microbes much less powerfully than 
others, and it has been found that it takes as long as two days 
for the destruction of the spores of the anthrax bacilli by a 
five per cent, solution. It has also been found, however, that 
the development and reproduction of many micro-organisms is 
greatly interfered with, or altogether prevented, as long as 
they remain in a solution of one part of carbolic acid to 400-600 
of water. It seems to be well established, moreover, that one 
per cent, in an aqueous solution will destroy with certainty the 
virulence of ordinary septic and purulent matters, of the tubercle 



58 PHARMACOLOGY AND THERAPEUTICS. 

bacillus, and of the micrococcus of fowl-cholera. While some 
of the putrefaction germs are also destroyed by solutions of 
this strength, it is requisite that the action should be maintained 
for about two hours in order to insure this, and for the destruc- 
tion of the infection of vaccine and of glanders a two per cent, 
solution is required. In oily solution the antiseptic influence 
of carbolic acid is extremely slight. 

Phenol has the property of precipitating albumins and other 
proteids in solution, and also whenever it comes in contact with 
the tissues, and its action in this respect has been compared 
with that of alcohol, in which the proteid is precipitated, it is 
alleged, not because an insoluble compound is formed, but be- 
cause of a change in the nature of the solvent. Hence it is 
argued that carbolic acid must penetrate more thoroughly than 
the metallic antiseptics, which are rendered insoluble by the 
albumin they meet, and whose action therefore tends to remain 
confined to the surface. In sufficient concentration carbolic 
acid has a mild escharotic action. When applied momentarily 
to the cutaneous surface it produces at first a burning sensation 
and a white discoloration, followed by a reddish stain, which 
gradually fades away as the skin desquamates. If the applica- 
tion be prolonged, a white opaque scar is formed, which after- 
wards becomes red and shining. When in the course of a few 
days it falls off, it leaves a light brown stain, which may persist 
for several weeks. If prevented from evaporating, the acid, by 
penetrating to the deeper tissues, may produce extensive dry 
gangrene of the part. Carbolic acid is a decided local anaes- 
thetic. The application of a solution even as weak as five per 
cent, at first causes a sense of tingling and warmth, and this is 
followed by one of numbness, as an accompaniment of opacity 
and shrinking of the epidermis. If a strong solution is em- 
ployed, the numbness amounts to almost complete anaesthesia. 
On the mucous membrane the acid has an escharotic effect 
which varies in degree according to the strength of the solu- 
tion. Applied to wounds or abraded surfaces, a five per cent, 
solution causes pain and irritation and the formation of a 
pellicle from the precipitation of proteids. 



PHENOL. 59 

Internal. G 'astro-intestinal Tract. — When taken in concen- 
trated form phenol causes burning pain, of short duration, and 
white eschars of the mouth, oesophagus and stomach (the 
mucous membrane appearing as if brushed over with a strong 
solution of silver nitrate and becoming hard and dry like 
leather), and, if death does not result at once, gives rise to 
violent gastro-enteritis, with its attendant vomiting and purging. 
The matters vomited have the characteristic odor of the drug. 
If taken in therapeutic doses, it produces a cooling and rather 
grateful sedative feeling in the stomach, and the bowels are 
unaffected by it. 

Blood. — According to the observations of some, the number of 
red blood-corpuscles is reduced. In toxic doses it sometimes 
appears to have a disintegrating effect on these cells. In one 
case of poisoning in man the presence of haemoglobin in the 
urine indicated the destruction of some of the corpuscles, and 
occasionally such destruction has been noted as a result of the 
direct injection of carbolic acid into the blood-vessels of ani- 
mals. While it gives rise to the slow formation of methsemo- 
globin when added to defibrinated blood, it has been found that 
this does not take place in the living animal. 

Circulation. — It has been demonstrated that one of the 
characteristic effects of carbolic acid, in large doses, is the 
reduction of the arterial pressure, and this appears to be princi- 
pally due to depression of the vaso-motor centre in the medulla 
oblongata. Weakness and slowness of the heart are observed, 
though at an earlier period there is cardiac acceleration, which 
is thought to result from the direct action of the drug on the 
muscle or on the regulating nerves. 

Respiration. — The respiration, like the heart, is accelerated, 
and as this quickening occurs previous to the increased muscular 
movement caused by the drug, it has been attributed to action 
on the medullary centre, which is first stimulated and subse- 
quently paralyzed; so that the breathing ultimately fails al- 
together. 

Nervous System. — The most marked effects of phenol after 



60 PHARMACOLOGY AND THERAPEUTICS. 

its absorption into the blood are upon the central nervous sys- 
tem. In mammalian animals it causes, with or without a pre- 
liminary stage of depression, marked muscular tremor, which 
at intervals is interrupted by sudden twitches in different 
muscles, and later by clonic convulsions. The respiration and 
the heart, as mentioned, are at first accelerated, but afterwards 
become slow, irregular and weak. The movements grow pro- 
gressively more feeble and appear at longer intervals, and the 
animal passes into a state of collapse, in which, however, the 
sensibility to pain is often preserved. Finally, death occurs 
from asphyxia. After very large doses the collapse may be 
immediate. No convulsions are observed, and the heart and 
respiration often cease simultaneously. In most cases there is 
an increased secretion of saliva, perspiration and tears, which 
is thought to be of central origin and possibly associated with 
the nausea and vomiting present. Frequently also the temper- 
ature falls far below the normal. In the frog a period of 
depression always precedes the increased movement. In man 
convulsions are comparatively rare, but delirium and excite- 
ment are sometimes seen. When the quantity of carbolic acid 
taken is large, immediate unconsciousness may occur, and death 
result in a few minutes, but how far this is due to the extensive 
local corrosion and how far to direct action on the central 
nervous system is unknown. Increased irritability of the spinal 
cord appears to be the cause of the convulsions in the frog, 
which are similar to those seen after strychnine, and of the 
sudden contractions of the muscles in mammals, but the clonic 
convulsions and the presistent muscular tremor observed in the 
latter point to a cerebral origin. The infrequency of convul- 
sions in man has not as yet been accounted for. The pupils, it 
may be noted, are almost invariably contracted in phenol 
poisoning; which is doubtless due to paralysis of the radiating 
fibres, the circular fibres being left unopposed. 

Temperature. — Phenol, in sufficiently large doses, causes a 
reduction of temperature which, as in the case of the antipyretic 
group, is probably due to some alteration effected in the heat- 



PHENOL. 6 1 

regulating nervous mechanism, resulting also in an increase in 
the dissipation of heat. In cases of poisoning, however, the fall 
would seem to be very largely due to the collapse. While it 
undoubtedly possesses the power of reducing the temperature to 
some extent in fever, ordinary medicinal doses of carbolic acid 
have very little effect in this direction in the normal subject. 
Urine. — It is a fact of considerable interest that the produc- 
tion of phenol occurs normally in the body, and that it is a 
constituent of the urine of man, as well as that of cattle, 
horses, dogs and probably other animals. It has been found to 
be constantly present also in normal human faeces, and it is 
considered probable that the acid is formed in the organism as a 
late product of the pancreatic digestion. Its elimination by the 
urine appears to be markedly affected by different diseases and 
conditions, being vastly increased in ileus, and diminished in 
anaemia, scurvy, tuberculosis and scrofula. One of the charac- 
teristic effects of the absorption of carbolic acid is a peculiar 
smokiness of the urine. The discoloration varies in intensity in 
different cases. It is often a dusky green, which may change 
to dark brown or even black. It has been found that the 
acid passes through the tissues largely unoxidized, but a certain 
proportion of it is partially oxidized to pyrocatechin and hydro- 
quinone, which combine in the body with sulphuric and gly- 
curonic acid and are excreted in the urine as double (ethereal) 
sulphates and phenol, pyrocatechin and hydroquinone glycuro- 
nates. Pyrocatechin and hydroquinone are unstable bodies, 
and their oxidation products are doubtless the cause of the dark 
urine; pyrocatechin can only exist in alkaline urine, so that it 
cannot be the sole cause of the dark color. The presence in 
the urine of these results of carbolic acid is recognized by 
reactions after distillation. The distillate gives a blue color 
with neutral ferric chloride, and a white crystalline precipitate 
of tribromophenol with bromine water, showing the presence of 
sulphocarbolic acid. The inorganic sulphates are usually ab- 
sent. This is determined by the use of the barium chloride test, 
which does not precipitate the combined sulphates (sulphocar- 



62 PHARMACOLOGY AND THERAPEUTICS. 

bolates) (Sonnenberg's test). The depth of the discoloration 
of the urine is said to depend on the quantity of dioxybenzols 
present, and not on that of phenol sulphate. Hence a darker 
shade is apt to be observed when the absorption of carbolic acid 
has occurred from an open wound (which presents conditions 
especially favorable to oxidation) than from much larger 
amounts absorbed from the alimentary canal. 

Therapeutics of Phenol. 
External. — Phenol was formerly employed in the form of a 
spray, with the idea of rendering the surrounding air antiseptic, 
during surgical operations, but is no longer used in this way, 
and in the treatment of wounds in general it has been largely 
superseded by germicides recognized as more efficient. By some 
surgeons, however, it is still held in esteem; carbolic lotion (i 
in 40) being used for the washing of wounds and carbolized 
gauze (bleached cotton gauze medicated with half its weight 
of a mixture of carbolic acid, 1 ; resin, 4 ; paraffin, 4) as an anti- 
septic dressing. It is also employed to a considerable extent as 
a disinfectant for surgical instruments, soiled linen, and hospital 
apparatus, and as a disinfectant and deodorant for bed-pans, 
privies, drains, etc. For the latter purposes and on the walls 
and floors the crude acid is preferable, as its principal impurity, 
cresol (cresylic acid) is a very powerful disinfectant, and also 
because it is cheaper in cost. As a local application carbolic 
acid is one of the most highly esteemed remedies, and is em- 
ployed in a great variety of conditions. It has sometimes been 
applied undiluted to wounds and burns, turning the tissues 
white and also exerting a haemostatic influence. Afterwards 
the surfaces are cleansed with sterilized water. The more 
usual form in which the acid is used in the treatment of burns 
is in that of carbolized oil. In carbuncle or malignant pustule, 
after incision and scraping, the undiluted acid acts as an anti- 
septic, and also relieves pain by its anaesthetic effect. Among 
the other conditions in which its application, undiluted, has 
proved efficient may be mentioned ulcers of the cervix uteri, 



PHENOL. • 63 

chronic endo-cervicitis and endometritis, lupus, mucous patches, 
condylomata and cauliform excrescences. Even in scirrhus 
such applications, together with the daily injection of a five 
per cent, solution of the acid beneath the cancerous growth, has 
been thought to limit the extension and retard the progress of 
the disease. In performing minor surgical operations local 
anaesthesia may be secured either by brushing over the surface 
with the pure acid or by soaking the part, when this is prac- 
ticable, for ten minutes in a 30 per cent, solution. A strong 
solution (such as 1 in 20) will alleviate itching from almost any 
cause, and on account of this anaesthetic action carbolic acid 
has been called the " opium of the skin." Its anti-pruritic and 
parasiticidal qualities render it a useful remedy in a large 
number of cutaneous affections. In vesicular eczema, ery- 
thema and in dermatitis, especially from poisonous substances, 
the following formula is strongly recommended; liquefied phe- 
nol, .36 c.c. (6 TR.) ; powdered zinc carbonate, 30 gm. (1 oz.) ; 
lime water and glycerin, aa 90 c.c. (3 fl. oz.). An ointment 
containing sulphur and camphor with carbolic acid has been 
found most effective in many pruritic skin diseases, especially 
papular eczema, psoriasis, lichen and urticaria. Scabies is said 
to have been cured by friction with carbolized oil of the strength 
of 1 to 15. The glycerite is a very serviceable form, and it 
may be used (generally diluted) with good results in such 
affections as prurigo, tinea versicolor, tinea tonsurans, and the 
other forms of tinea. It is also applied as a stimulant to indo- 
lent ulcers and to the patches of aphthous stomatitis. A car- 
bolic lotion, to which glycerin or sweet oil may be added, is 
very efficient in allaying the itching of jaundice. It has like- 
wise been used to prevent pitting from small-pox, and an oint- 
ment containing carbolic acid and camphor has proved of ser- 
vice in alleviating the itching accompanying that disease. In 
the vulvitis or leucorrhcea of young girls, injections of the acid, 
in the strength of 5 parts to 1000 of water (pads of lint 
saturated with the same solution being used to separate the 
inflamed parts in the intervals) are said to be beneficial, and 



64 PHARMACOLOGY AND THERAPEUTICS. 

in the gonorrhoea of females a somewhat stronger solution, to 
which alcohol or cologne water is added. The strong acid is 
generally successful in relieving the pain of a carious tooth, 
but the pledget of cotton on which it is inserted into the cavity 
should be covered with dry cotton, in order to prevent its 
coming in contact with the gum and possibly causing sloughing. 
In ulcerated sore throat, tonsillitis, diphtheria and other throat 
affections a one per cent, solution in water and glycerin is 
useful as a gargle or wash for cleansing purposes, and also for 
the alleviation of pain, while a concentrated solution in glycerin 
is sometimes applied as a mild caustic. In " hay-fever," influ- 
enza and acute and chronic nasal catarrh, also, weak solutions 
are topically used to a large extent (frequently by means of 
the atomizer), and a favorite one is that of Dobell, which con- 
tains, in addition to carbolic acid, sodium borate and sodium 
bicarbonate, with glycerin. In acute coryza the combination of 
the fumes of carbolic acid and iodine is often very beneficial. 
For this purpose a mixture of the acid and tincture of iodine, 
dropped upon a sponge placed in a wide-mouthed bottle, may 
be volatilized by wrapping the latter in a cloth wrung out of 
hot water, or even by the heat of the hand. The spray from a 
steam atomizer supplied with a 5 per cent, solution of the 
acid alone is also of service, and in acute conjunctivitis marked 
relief is afforded by holding the eye open in a spray of this 
kind. The use of the following formula has been very highly 
commended in the treatment of whooping-cough; Phenol, .36 
gm. (6 gr.) ; menthol (4 per cent, solution), 15 c.c. (4 fl. dr.) ; 
cocaine hydrochlorate (3 per cent, solution), 11 c.c. (3 fl. dr.) ; 
glycerin, 4 c.c. (1 fl. dr.); cherry-laurel water, 30 c.c. (1 fl. 
oz.). This mixture is to be inhaled every three hours, from an 
atomizer, the nozzle of which is inserted as far as possible into 
the mouth of the patient. 

The deep-seated injection of phenol has been successfully 
practised in the treatment of lupus, ulcerations, poisoned 
wounds, erysipelas, secondary syphilitic abscesses, fistulae, en- 
larged bursas, synovitis, etc. In synovitis the injections are 



PHEXOL. 65 

made into the affected joint. A solution of the strength of 
from 2 to 5 per cent, is commonly employed, but in the case of 
hydrocele the pure acid is sometimes injected into the sac, after 
the removal of the fluid. Piles are also efficiently treated with 
injections of carbolic acid, either pure or diluted with oil, but 
some accidents have been reported from the procedure. In the 
early stage of boils and carbuncles the formation of pus is 
said to be prevented by the use in this way of weak solutions, 
and gangrenous and necrotic anthrax has been reported to be 
cured by frequent injections of a 3 per cent, solution. It is 
recommended that the hypodermatic needle should be inserted 
obliquely to the centre of the inflamed tissue (the skin having 
been first anaesthetized by the application of the acid or an 
ether spray), and that it should not be connected with the 
syringe until it has been observed whether any blood escapes 
from it. which would indicate that it had entered a vein. It 
may also be mentioned that good results have been claimed 
from the parenchymatous injection of phenol in pleuro-pneu- 
monia. septic puerperal fever, acute and subacute rheumatism, 
malarial fever, tetanus and other diseases. 

Internal. — Phenol is a very useful remedy in gastro-intestinal 
irritation, especially in cases associated with or dependent upon 
fermentative changes from imperfect digestion, and also where 
the disturbance is characterized by a nervous element. Vomit- 
ing and flatulence, as well as gastrodynia. may often be re- 
lieved by it, and it is of great service in many cases of diar- 
rhoea. For the latter condition it is very generally combined 
with bismuth subnitrate (.60 to 1.20 gm. ; 10 to 20 gr.), and 
administered either in emulsion or in capsules. Carbolic acid 
has been tried in a number of zymotic diseases, and while opin- 
ions differ as to its efficacy, considerable evidence has accu- 
mulated in its favor. In a part of India where the mortality 
from typhoid fever had previously been very great, admirable 
results in this disease were obtained from the use of a mixture 
containing carbolic acid and spirit of chloroform. The pure 
acid has also been employed successfully. .16 gm. (2 l / 2 gr.) 
6 



66 PHARMACOLOGY AND THERAPEUTICS. 

being administered at a time, in the form of a pill coated with 
keratin, in order to delay solution until after passing into the 
intestine. Another way of exhibiting phenol in typhoid which 
has won considerable favor is in conjunction with tincture of 
iodine, the two remedies sometimes being given in infusion of 
digitalis. When iodine and phenol are thus employed together, 
a colorless carbolate is said to be formed when they are dropped 
into water. The most remarkable results from carbolic acid 
have been reported in the treatment of scarlet fever. In this 
plan of treatment the acid is given in doses of from .06 to .36 
gm. (1 to 6 gr.), according to the age of the child, freely diluted, 
every two hours. The remedy is designedly pressed to the point 
of causing carboluria, and this condition is maintained until 
the fever is fully abated. So far from this proving injurious 
to the kidneys, it has been found that renal complication, which 
ordinarily occurs quite frequently in this disease, is exceedingly 
rare; while the cases thus treated prove in other respects very 
mild. It would seem, therefore, that the opinion which has 
prevailed in the profession, that when the urine begins to 
assume a smoky hue it should be regarded as a warning of 
danger, is an erroneous one. It is stated, furthermore, that the 
infection communicated by these carbolized patients is extra- 
ordinarily light, but yet sufficient to confer permanent immunity; 
so that it has been urged that it is better to let children take 
the disease in this modified form, rather than to leave them to 
the chance of contracting it later in its normal virulence. 
Where this was refused, however, it has been found that light 
carbolization of those exposed gives immunity for the time 
being. Strong evidence has also been educed of the great 
value of large doses of phenol in the treatment of influenza, 
particularly in the later stages of the disease, which often prove 
so intractable. In tetanus it is claimed that as good results 
have been obtained from carbolic acid as from the use of anti- 
toxin. It is usually given hypodermatically in a two per cent, 
solution, from .30 to 1 gm. (5-15 gr.) being administered in the 
twenty-four hours. It is thought by some authorities that it 



PHENOL. 67 

neutralizes the tetanus poison in the same manner as the anti- 
toxin. Its use is advocated on the ground that in addition to 
being an antidote to the toxin, it acts as an anaesthetic and 
general antiseptic. In erysipelas it has been given by the 
mouth and subcutaneously, as well as by deep-seated injection 
at the affected part. Large doses by hypodermatic injection 
have been recommended in bubonic plague, and cases of re- 
covery under this treatment have been reported. Phenol ap- 
pears to have a distinctly curative effect in malarial fevers, and 
the combination of the acid with iodine in chronic malarial 
infection, as well as in the more acute cases after quinine has 
stopped the paroxysms, has been found of great value. In 
gangrene of the lung the internal administration of carbolic 
acid combined with the use of a weak solution by atomization 
is said to be very advantageous. In this condition, however, 
as well as in pulmonary tuberculosis, creosote is generally con- 
sidered preferable at the present time. 

Cresol has an action very similar to that of phenol, while its 
germicidal power is said to be nearly three times as great as 
that of the latter. It may be used internally and in surgery for 
the same purposes as carbolic acid. It has been recommended, 
in a 1 to 1000 solution, as a solvent for atropine and other 
drugs employed in ophthalmic practice; it being claimed that 
such solutions are non-irritant and that they remain free from 
bacteria. 

Chlorophenols. — By the action of chlorine upon carbolic acid 
a mixture of ortho- and parachlorphenol is produced, and if 
the action is sufficiently continued, trichlorphenol results. It is 
alleged that these compounds are very powerful germicides, 
the 2 per cent, solution being stronger than the 5 per cent, 
carbolic acid solution, and but slightly weaker than the one- 
thousandth solution of mercuric chloride. 

Phenosalyl is an antiseptic mixture composed of 90 parts of 
phenol, 10 parts of salicylic acid, 20 parts of lactic acid, and 1 
part of menthol. It is said to possess much greater antiseptic 
power and to be considerably less poisonous than carbolic acid. 



68 PHARMACOLOGY AND THERAPEUTICS. 



TOXICOLOGY. 

Phenol is employed for suicidal purposes far more frequently than any 
other poison, principally for the reason that it can be so readily ob- 
tained, and also, no doubt, because its lethal action, if the dose is suf- 
ficiently large, is so extremely prompt. Death has been known to occur 
within three minutes! In surgical practice the free use of the drug is 
not unattended with danger. Cases have been observed in which pa- 
tients have passed, immediately after the application of carbolic dress- 
ings, into a condition of collapse similar to the shock following severe 
injuries or surgical operations. Of five such cases related by one au- 
thor, recovery took place in only one instance. In other cases the 
poisoning occurs gradually and insidiously, and may be mistaken for 
septicaemia. The correct diagnosis can be determined by an examina- 
tion of the urine. Cases have been reported in which, in addition to 
wounded surfaces, poisoning has occurred from absorption from the 
skin, the rectum, and the uterine and other cavities. The effects of 
the drug when taken by the mouth have already been described. Be- 
sides the local action of the acid, the warnings of danger have been 
pointed out to be sudden vertigo, contracted pupils, pallor of the face, 
enfeebled circulation, and embarrassed respiration. If the amount 
taken is sufficiently large, the patient rapidly passes into insensibility. 
The symptoms frequently resemble very closely those of apoplexy, but 
the odor of carbolic acid may generally be detected in the breath and 
the characteristic corrosion produced by the acid be found to be present 
on an examination of the mouth. It is a fact, deserving of note that in 
some instances where consciousness had been restored and the condition 
otherwise become markedly improved, the patient after a number of 
hours sank rather suddenly into fatal collapse. 

Post-mortem. — If death has occurred quickly, the tissues and organs 
will smell distinctly of the drug. The mucous membrane of the mouth, 
pharynx, oesophagus and stomach, wherever acted upon by the poison, 
is found to be corrugated, tough and discolored. It is generally whitish, 
changing to a brownish color, and the corrosions may be surrounded by 
a zone of inflammatory redness. In some instances, where the pure 
liquid acid has been swallowed, the appearance is that of a broad choco- 
late-colored slough, extending continuously from the lips down into the 
stomach, and involving more or less of the gastric mucous membrane. 
The blood is dark-colored and generally coagulated in the heart and 
great venous trunks, although it has been maintained by some authori- 
ties that in consequence of the alteration in its character caused by the 
drug it coagulates with difficulty. While, however, the heart may be 



PHENOL. 69 

distended with loose clots, it is sometimes found empty and contracted. 
Acute fatty degeneration of the heart, as well as of the liver, kidneys 
and other organs, it is asserted, has been found in some cases. 

Treatment. — Many of the cases of poisoning met with present very 
little hope of amelioration from whatever measures may be adopted. 
If the drug has been taken by the mouth, the stomach should be promptly 
evacuated by means of the stomach-pump or the hypodermatic adminis- 
tration of apomorphine hydrochloride, and demulcents, such as white 
of egg or thick soap-suds, given. Oils should not be used, as they are 
liable to increase the absorption of the poison. Saccharated lime should 
be administered, in the hope that an insoluble combination may be 
formed in the stomach. Soap is also considered a chemical antidote. 
In view of the fact that in the tissues carbolic acid forms a compara- 
tively harmless compound with sulphuric acid, the exhibition of sodium 
sulphate has been advocated by many authorities ; but it is stated that 
practically this is of little or no benefit, either because the tissues are 
entirely paralyzed by the excess of carbolic acid, or more probably be- 
cause the latter does not combine with sulphates as such in the body, 
but with organic sulphur compounds which are only in process of being 
oxidized to sulphuric acid. It is of the utmost importance to immedi- 
ately give stimulants freely, such as ether or brandy subcutaneously. 
Alcohol should also be given by the mouth, as pure alcohol is the most 
important antidote to phenol known. Success in this treatment demands 
that the acid and alcohol should be brought in contact ; therefore if the 
acid has been swallowed for some time alcohol may not be efficacious. 
Atropine has also been recommended as an antidote, experiments on 
animals showing results which point strongly to the existence of the 
antagonism, and it is reported to have succeeded in some very unpromis- 
ing cases. At all events, such stimulants to the central nervous system 
as atropine, camphor and caffeine are generally called for, and artificial 
respiration should be resorted to in all serious cases. Hot applications 
and friction should also be employed to combat collapse. Cider vinegar 
is stated to be one of the antidotes of carbolic acid, having the effect 
when applied to a cutaneous or mucous surface which has been burnt 
by it of causing the prompt disappearance of the characteristic white 
eschar produced by the acid, and also of preventing subsequent scarring 
to a large extent. As it is supposed to be equally efficacious when the 
poison has been taken into the stomach, vinegar diluted with an equal 
quantity of water may be given if the patient is able to swallow. This 
article has the advantage of being always procurable without delay. 
When practicable, the patient's bowels should be moved with sodium, 



JO PHARMACOLOGY AND THERAPEUTICS. 

or magnesium, sulphate, and it is advised that the soluble sulphates 
should be administered in small doses for several days, with the idea 
of facilitating the elimination of the phenol from the system. 

THE PHENOSULPHONATES. 

1. SODII PHENOSULPHONAS (Sodii Sulphocarbolas, U. S. P., 
1890). — Sodium Phenosulphonate. (Sodium Sulphocarbolate.) Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

2. ZINCI PHENOSULPHONAS.— Zinc Phenosulphonate. (Zinc 
Sulphocarbolate.) Dose, 0.125 gm. (125 milligm.); 2 gr. 

Action of Sodium Phenosulphonate. 
It is less irritant and less poisonous than phenol, and while 
it is stated to possess less antiseptic power than the latter, has 
considerable efficiency as a gastro-intestinal antiseptic and dis- 
infectant. It does not cause smoky discoloration of the urine, 
and appears to be excreted in that fluid unchanged. 

Therapeutics of Sodium Phenosulphonate. 
The sulphocarbolates were introduced for the purpose of 
securing, if possible, the antiseptic and antipyretic action of 
phenol without the caustic and depressing action of the drug. 
While sodium phenosulphonate does not perhaps altogether 
maintain the position anticipated for it, it may in some instances 
be used with advantage as a substitute for carbolic acid. It 
is employed as a topical application to inflamed and diseased 
mucous membranes, and internally as a remedy for fermentative 
dyspepsia. It has also been given in typhoid fever and other 
infectious diseases, such as septicaemia, puerperal fever, and 
the exanthemata, and successful cases have been reported from 
its use even in malignant endocarditis. 

Action of Zinc Phenosulphonate. 
It is antiseptic, but less actively so than phenol, and its 
action is the same as sodium phenosulphonate and other pheno- 
sulphonates, except that it is decidedly more astringent. 



LYSOL. J I 

Therapeutics of Zixc Phenosulphonate. 
It is employed as an astringent for indolent or foul ulcers, 
and in subacute inflammations of mucous membrane, in solu- 
tions which are somewhat stronger than those of zinc sulphate 
in use. It is thought by some that it may replace the sulphate 
as an astringent. Internally it has been used to some extent as 
an intestinal antiseptic, and has been recommended in typhoid 
fever as having the advantage, over the phenol-and-iodine treat- 
ment, of being less depressing to the heart and less injurious to 
the kidneys. Some good results have been reported from doses 
of .12 to .20 gm. (2 to 3 gr.) four or rive times a day. 

LYSOL. 
LYSOL.— Lysol. (Xot official.) Dose, 0.06 to 0.50 gm.; 1 to 8 gr. 

Action of Lysol. 
Lysol is an antiseptic, about one eighth as poisonous as car- 
bolic acid, and even less poisonous than creolin {see p. 72). In 
sufficient quantity, however, it may produce fall of temperature 
and general depression, with nephritis, and a few fatalities have 
been reported from its use. Experimental research is said to 
have shown that both in pure cultures and in mixed masses of 
pathogenetic bacteria it acts more energetically as a germicide 
than either phenol or creolin; also that, except in strong 
solution, it is non-irritating, so that wounds may be absolutely 
disinfected by spraying with a 3 per cent, solution. Solutions 
of this strength, and even weaker ones, may produce a slight 
burning when applied to mucous membranes, but it is only 
transient. A solution of 1 part in 200 has been found to de- 
stroy streptococci in fifteen minutes. 

Therapeutics of Lysol. 
The official cresol has the same properties and uses as lysol. 
The latter is used locally in from one half to two per cent, aque- 
ous solution. The literature is extensive and generally favor- 
able. The value of this agent as an antiseptic has been con- 



72 PHARMACOLOGY AND THERAPEUTICS. 

firmed by many surgeons, although some of them have found 
it a little more irritating than was at first supposed to be the 
case. It is employed in much the same conditions as creolin, 
and has also been successfully tried in the treatment of lupus, 
pityriasis versicolor, and other skin diseases. It is used to 
some extent in obstetrical and gynaecological practice. Being 
readily soluble, a good antiseptic and deodorant, and inexpen- 
sive in cost, it is very serviceable for the disinfection of stools, 
sputa, privies, walls, floors, etc. It does not injure either 
metallic or rubber instruments, but, like creolin, it renders 
them difficult to grasp firmly. On celluloid articles it has a 
deleterious action. For cleansing the hands a one per cent, 
solution may be used, but it is said to be necessary that 
the water should be so hot as to be just short of boiling, 
which would make it somewhat painful when the hands 
are first introduced. Internally lysol has been given with good 
results in dyspepsia, in doses of .06 to .50 gm. (1 to 8 gr.), the 
taste being disguised with peppermint. It is stated that the 
use of about 500 c.c. (1 pint) of a 1 per cent, solution as an 
enema three times daily has been found of service in dysentery. 

Izal, which is chiefly used in England, is a coal tar deriva- 
tive possessing similar properties and employed for the same 
purposes. 

CREOLIN. 

CREOLINUM.— Creolin. (Not official.) 

Action of Creolin. 
Creolin is a non-irritating antiseptic of considerable activity, 
though its germicidal power has been overrated by some writers. 
Its internal administration is said to have produced restlessness, 
anxiety, nausea, amblyopia and a tendency to syncope, at the 
same time giving rise to a peculiar strong taste of tea or of 
smoke. In some of the cases observed the urine was dark- 
colored and markedly albuminous. The case is recorded of an 
infant three weeks old who was fatally poisoned by thirty drops 
of the undiluted drug. The chief symptoms were those of 



CREOLIX. 73 

violent irritation of the mouth and the upper respiratory and 
digestive tracts, and death occurred chiefly through inflamma- 
tion of the glottis. Creolin. however, is one of the least toxic 
of all the powerful antiseptics. It has the additional advantage 
of exerting a local influence resembling that of oily or muci- 
laginous preparations, instead of the irritating effect of carbolic 
acid. As compared with the latter agent, its germicidal power 
is somewhat smaller, since it is not efficient, in solutions con- 
taining albumin, in the strength of less than I to ioo; but as 
its poisonous qualities are decidedly less marked, it can be used 
in stronger solutions than phenol. For practical purposes, 
therefore, it is really a more powerful antiseptic. Toxic symp- 
toms have been observed but rarely from the use of creolin. 

Therapeutics of Creolin. 
As an antiseptic, creolin is frequently employed in place of 
carbolic acid. It is used pure, in 2 per cent, solution, in an 
ointment in gauze (5 to 10 per cent.), or as a soap (10 per 
cent.). It has been found of service in obstetrical and gynaeco- 
logical practice, and in diseases of the eye. ear, nose and throat, 
as well as in general surgery. In gonorrhoea it is used both in 
the form of bougies and of injections with olive oil (1 to 3). It 
is an excellent disinfectant for the hands, a 5 per cent, solution 
neither cracking the skin nor benumbing the sensory nerves. 
It is not well adapted for cleansing instruments, however, as 
the opacity of its solution prevents them from being seen at the 
bottom of the vessel. It also covers them with a soapy film.- 
which renders them somewhat slippery. While it does not 
corrode metal, it acts rapidly upon caoutchouc and gutta-percha. 
Its use by enema has proved valuable in both acute and chronic 
dysentery and in the diarrhceal diseases of children. The 
strength of the solution for injection should be about 5 to 1000 
for adults, and weaker than this for infants. It has been given 
internally in gastric fermentation, dysentery and typhoid fever. 
It has been recommended as a deodorant to iodoform. A 
mixture of from 1 to 2 per cent, produces a compound known 



74 PHARMACOLOGY AND THERAPEUTICS. 

as creolin-iodoform, with a faint aromatic odor, which is be- 
lieved to possess the therapeutic properties of iodoform. The 
creolin may be removed from it by water, leaving the iodoform. 
Jeyes' disinfectant preparations contain creolin. The official 
cresol can well be employed in place of creolin. 

IODINE. 

1. IODOFORMUM.— Iodoform. Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Preparation. 
Unguentum Iodoformi. — Iodoform Ointment. 

2. THYMOLIS IODIDUM.— Thymol Iodide. (Aristol.) 

3. IODOLUM.— Iodol. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 
Europhenum. — Europhen. (Di-isobutyl-ortho-cresol Iodide.) 
Losophanum. — Losophan. (Tri-iodo-meta-cresol.) 
Acidum Di-iodosalicylicum. — Di-iodosalicylic Acid. 
Sozoiodolum. — Sozoiodol. (Soziodolic Acid.) 
Acidum Iodosalicylicum. — Iodosalicylic Acid. 

Action of Iodoform. 
External. — Locally iodoform is capable of inducing analgesia 
of the rectum and the bladder, and when applied in considerable 
quantity to wounded surfaces also has considerable anaesthetic 
effect. In exceptional instances (for the most part confined 
to individuals with a predisposition to cutaneous affections) it 
gives rise to a certain amount of irritation, or efflorescence, 
and even to papular or eczematous eruptions, in the vicinity of 
such surfaces. On sound integument it ordinarily has no local 
action. Although it was formerly believed to be of very pro- 
nounced antiseptic value, it has since been demonstrated that 
this opinion was founded on a misapprehension; pathogenic 
microbes frequently developing as rapidly after having been 
exposed to its action as in the control cultures. When it was 
shown that iodoform itself has no germicidal properties, the 



IODINE. 75 

theory was advanced that it only acts as an antiseptic after its 
decomposition, this resulting in the liberation of free iodine, 
which exerts an antiseptic influence. According to the best 
authorities, however, more recent investigations indicate 
that microbes found in wounds under iodoform treatment 
are not retarded or weakened in their development; proving, 
apparently, that the beneficial effects of such treatment are not 
due to any poisonous action on the germs. At present it is 
held that whatever benefits attend the use of iodoform dress- 
ings must be explained on the ground of a supposed action on 
the wounded surface, in consequence of which it secretes less 
fluid, and thus affords a less suitable medium for the growth of 
the germs. It is thought also that such growth may to some 
extent be retarded by the formation by the iodoform of a crust, 
which mechanically prevents microbes from penetrating to the 
wounded surface. The favorable results which have been 
observed from the application of iodoform to tuberculous ulcers 
of the larynx, tuberculous abscesses, and similar conditions are 
probably due to its beneficial effect on the granulation tissue, 
rather than to a specific action upon tuberculous disease, which 
many have regarded it as possessing. 

Internal. — From moderate amounts of iodoform the most 
constant symptoms produced are headache, more or less nausea 
and vomiting, and an unpleasant taste and smell of the drug 
in the nose and mouth. When it is taken into the system in 
larger quantities there is experienced the same taste and odor, 
the headache is accompanied with giddiness, and the patient is 
restless, uncomfortable, and unable to sleep. The action of the 
heart is feeble and accelerated, the pulse sometimes reaching 
180, and there is a rise of temperature to 104° F., or even 
higher. From the first there is anxiety and a general depression 
which increases as the case progresses. This deepens into true 
melancholia, with hallucinations, generally succeeded by violent 
delirium and mania, which may last for days or terminate in 
a shorter time in fatal collapse. In exceptional instances there 
is an entire absence of signs of cerebral excitement, and the 



y6 PHARMACOLOGY AND THERAPEUTICS. 

patient sinks into a profound sleep, ending in coma and col- 
lapse. Of all the symptoms of iodoform intoxication, the most 
characteristic are the delirium and mania. They are not de- 
veloped in the same intensity and of equal duration by any other 
poison, but it is not known what changes take place in the brain. 
In striking contrast to the case of man, it is stated that no 
similar effects have been observed in animals. The cerebral 
symptoms appear to be attributable to iodoform which circu- 
lates unchanged in the blood. Some of the other symptoms 
are no doubt due to iodine set free by the decomposition of a 
considerable portion of the iodoform and to the iodides which 
some of the nascent iodine forms by combining with the alka- 
lies of the fluids. After iodoform absorption iodine is present 
in the saliva, perspiration and other secretions, but it is found 
to be chiefly excreted in the urine in the form of iodides. The 
elimination from the tissues seems to be very slow, since iodides 
are stated to have been detected in the urine more than a month 
after the administration of iodoform. When renal disease is 
present, the drug should always be used with caution, as under 
these circumstances excretion takes place even more slowly 
than usual, and the iodoform products are liable to accumulate 
in the tissues. The cardiac acceleration noted is thought to be 
probably caused by abnormal activity of the cells of the thyroid 
gland, as the thyroid secretion has been found to be very con- 
siderably increased by iodoform, like other substances from 
which iodine is liberated in the tissues. Children, it is stated, 
are less susceptible to the poisonous effects of iodoform than 
adults. While iodoform is absorbed slowly by the alimentary 
canal, it is taken up quite freely in wounds, and many cases 
of poisoning have occurred in this way. 

Therapeutics of Iodoform. 

External. — Whatever may be the explanation of its local 

action, there can be no question of the great practical value of 

iodoform as a surgical dressing. In the last twenty years it 

has had an enormous vogue, and while, on account of its ex- 



IODINE. 77 

tremely disagreeable odor and the numerous accidents which 
have attended its use, various substitutes for it have been pro- 
posed and have proved more or less successful, it is still em- 
ployed to a very considerable extent. To attempt to recount all 
the various conditions in which it has proved of service would 
be an interminable task, and is unnecessary here. One of its 
most important applications, and that which first directed gen- 
eral attention to its usefulness, is as a dressing for wounds. 
The common practice is to sprinkle it freely upon the part and 
secure it in place by a dry dressing. Since iodoform is not, as 
explained above, itself antiseptic, it must, before being used, 
be either sterilized or disinfected by washing in a I to 2000 solu- 
tion of corrosive mercuric chloride solution, and preserved, 
while damp, in closed sterilized jars. It is employed in the treat- 
ment of all sorts of wounds, ulcers and sores, and is found 
especially serviceable in tuberculous and syphilitic ulcerations. 
Usually the dry powder is simply dusted upon them, but iodo- 
form is also employed in a variety of different combinations. 
One of these is a solution in collodion (1 part of iodoform to 12 
of flexible collodion), which is painted over wounds, venereal 
sores, etc., with good effect. Another is a mixture of equal 
parts of iodoform, glycerin and alcohol, which is used for in- 
jecting tuberculous abscesses. For the relief of chronic cystitis 
injections have been given of iodoform dissolved in ether 
(1 in 8), of iodoform, starch and water, and of a solution of 
iodoform in glycerin and water. The latter may be made as 
follows : Iodoform, moistened with alcohol, 1 ; boiling water, 2 ; 
glycerin 7, and it is also useful for injection into abscess cavi- 
ties, sinuses, etc. In fissure of the anus and diseased and pain- 
ful conditions of the rectum the iodoform suppository (B. P., 
each .20 gm. ; 3 gr. in .80 gm. ; 12 gr. of oil of theobroma) 
serves an excellent purpose. Similar vaginal suppositories have 
been largely used in affections of the uterus and vagina, and 
powdered iodoform is sometimes introduced into the dilated 
cervix uteri by insufflation. In the uterus, the urethra and in 
the nose, as well as in sinuses and other deep and narrow 



yS PHARMACOLOGY AND THERAPEUTICS. 

cavities, bougies made with cocoa-butter, mucilage and glycerin, 
or gelatin, may be employed. Mixed with bismuth subnitrate 
and starch it is used with benefit, by insufflation, for ozaena, 
ulcers of the mouth and fauces, and tuberculous ulcerations of 
the larynx. Syphilitic ulcers of the pharynx are sometimes 
treated also with the ethereal solution and with gelatin lozenges 
each containing .06 or .12 gm. (1 to 2 gr.) of iodoform. In 
ozaena, whether of the simple or syphilitic form, iodoform may 
be used in an ointment prepared with vaselin, or by means of 
absorbent cotton impregnated with it, instead of by insufflation. 
Iodoform cotton is useful as an application to the rectum and 
vagina, as well as the nostrils. In various forms iodoform is 
employed to a considerable extent in diseases of the eye and 
ear. In chronic suppuration of the middle ear, but more 
especially of the internal auditory canal, it is regarded by many 
as excelling all other applications in diminishing the discharge, 
correcting its fetor, and restoring the part to its normal condi- 
tion. Iodoform gauze, which may be made by saturating the 
material with a concentrated ethereal solution and afterwards 
drying, is much used in operations involving the peritoneum, 
intestine, etc., and in contused, complicated and other wounds 
where good drainage is required. It is efficient also in the treat- 
ment of open cancer, buboes, boils and carbuncles after incision, 
many of the lesions of scrofula, lupus and syphilis, and a variety 
of other conditions. A 4 per cent, solution of iodoform in oil 
of turpentine, administered in the form of inhalation, may some- 
times be used with advantage in laryngeal tuberculosis, bron- 
chorrhcea, and other affections of the respiratory apparatus, and 
good results have been reported from iodoform injections in 
the treatment of goitre and of tuberculous joints and lymphatic 
glands. A number of cases of tuberculosis of the bladder are 
reported to have shown more or less improvement under the 
use of a mixture of iodoform and vaselin. A novel use has 
recently been made of the drug, in the form of " iodoform 
plugs," employed for filling up cavities produced by diseased 
tissues, and the treatment is stated to have been especially sue- 



IODINE. 79 

cessful in bone cavities. They are composed as follows : Iodo- 
form, 3 to 6; spermaceti, 4; oil of sesame, 2. In exceptional 
instances iodoform, instead of having a healing and beneficial 
effect upon wounds, sores, ulcers, etc., causes marked irritation, 
necessitating its replacement by other applications. As the 
disagreeable odor of iodoform constitutes a very serious objec- 
tion to its use, various means have been tried to obviate this, 
but none of them with very marked success. Among the agents 
which have been employed to conceal the odor may be men- 
tioned musk, cumarin, creolin and balsam of Peru, and the oils 
of eucalyptus, turpentine, bergamot, geranium, peppermint, 
sassafras, cinnamon, lavender and thyme. Of these, oil of 
geranium (1 to 25) is probably the best. Some believe that 
the odor of iodoform is preferable to that of musk. By keep- 
ing a Tonka bean or ground roasted coffee with it, the odor is 
lessened. It is claimed that the odor will rapidly disappear 
from the hands of the surgeon if they be washed with orange 
flower water or with flaxseed meal in water. It has been 
pointed out also that as chloroform and ether are solvents of 
iodoform, they may be successfully used for removing its odor 
from the hands, nails and clothing. An " odorless iodoform " 
has been put upon the market, which is said to differ from ordi- 
nary iodoform only in that hydrogen is absent from its formula. 
It is claimed that it is equally efficient with the latter, but 
whether this claim is justified seems to be as yet undetermined. 
Internal. — On account of the great success of iodoform in 
surgery as a supposed antiseptic, it was anticipated that it 
would prove of decided benefit internally in many of the 
infectious diseases, and on account of the large amount of 
iodine in its composition (with the advantages of being non- 
irritant and having an organic nature), more especially in such 
affections as syphilis, scrofula and tuberculosis. It was there- 
fore given an extended trial, both by the mouth and by sub- 
cutaneous injection; but the expectations in regard to its 
efficacy were not at all realized, and although occasional reports 
of its use in various affections still continue to be published, it 



80 PHARMACOLOGY AND THERAPEUTICS. 

has been practically abandoned as an internal remedy by the 
mass of the profession. 

TOXICOLOGY. 

Many deaths have been occasioned by the too free use of iodoform 
as an external application, and in the aged especially more or less severe 
poisoning is liable to occur from this cause. A surgeon who has em- 
ployed iodoform in several thousand cases without a single instance of 
poisoning attributes this favorable result to the following circumstances : 
that he did not use large quantities of the remedy, that the wound was 
not subjected to pressure, and that carbolic acid was not employed at 
the same time. It is a recognized fact, however, that in certain indi- 
viduals there is an idiosyncrasy which renders them peculiarly suscep- 
tible to the action of the iodides in general, and often particularly so 
to iodoform. It has been found that in some instances this idiosyncrasy 
develops suddenly and without warning ; grave toxic symptoms occurring 
at once and death quickly ensuing, notwithstanding the withdrawal of 
the remedy. The following test for iodoform intoxication is of value 
if the patient is not at the same time using other preparations contain- 
ing iodine : A few drops of the urine is mixed with a small quantity of 
calomel on a white plate, by means of a glass rod ; when a well-marked 
yellow discoloration will be produced if the urine contains sufficient io- 
dine to indicate the absorption of a dangerous amount of iodoform. 

Post-mortem. — Fatty degeneration of the heart, liver, kidneys and 
muscles is generally found. Among the other conditions observed are 
ecchymoses in the kidneys, beneath the endocardium, and in other parts 
of the body, congestion of the meninges, and reddening of the mucous 
membrane of the gastro-intestinal tract, frequently associated with 
degeneration of the epithelial cells. 

Treatment. — The first measure to be adopted is the complete removal 
of all iodoform that has been applied and the washing of the part with 
a solution of sodium bicarbonate. In the milder cases of poisoning 
nothing further than this may be required. In more serious cases 
stimulants are called for, and small doses of tincture of opium fre- 
quently repeated, are recommended by some authorities as being espe- 
cially useful. At the same time elimination should be promoted by 
sponging the body with warm water and the free administration of 
diaphoretics and diluents, such as potassium acetate, lemonade, etc. 
Potassium bicarbonate, .60 gm. (10 gr.) of which may be given every 
hour, is thought to have the effect of counteracting the toxic effects 
of iodoform, and potassium bromide, which is more active as a solvent 
for this substance than any other salt, is also considered an antidote. 



IODINE. 8 1 

Action of Thymol Iodide. 

Aristol is non-irritant and in its general local action resembles 
iodoform. It is, however, less desiccant than the latter, as the 
thymol appears to have some effect in increasing moisture. It 
possesses the great advantage of being practically odorless. It 
is claimed to be non-toxic, but it is possible for its prolonged 
use to give rise to chronic iodine poisoning. It has been 
demonstrated to have no influence upon the lower organisms, 
and is not, therefore, directly antiseptic. In regard to its 
elimination, very little is known, but it would seem to be 
partially decomposed in the system. Iodine has been found 
present in the urine of animals to which it was given in con- 
siderable quantities, but no traces of thymol have been de- 
tected. 

Therapeutics of Thymol Iodide. 

Aristol has proved in many respects a very useful substitute 
for iodoform. In surgery when dusted upon serous membranes, 
however, it tends to prevent their adhesion, and in the treat- 
ment of wounds and sores it is contra-indicated when secretion 
is free. It is used for the same purpose as iodoform in cutane- 
ous affections, such as lupus, psoriasis and eczema, in syphilitic 
lesions, and in a great variety of diseased conditions of the 
mucous membranes, and is very efficacious in the treatment of 
burns. It is employed as a powder and in flexible collodion, 
solutions in oil or ether, and ointments made with lanolin or 
vaselin. Heat should not be used in dispensing it, as the iodine 
in its composition is readily set free; and it should not be mixed 
with alkalies, metallic oxides, or starch. 

Action of Iodol. 
Iodol is a cicatrizing agent with properties similar to those 
of iodoform, as a substitute for which it was first introduced. 
It is without odor and does not produce stomatitis or nasal 
catarrh. It is decomposed in the tissues, and iodides are 
excreted in the urine. Its iodine is said to be less easily split 
off the molecule than that of iodoform, and it has been found 
7 



82 PHARMACOLOGY AND THERAPEUTICS. 

less liable to cause poisoning than the latter; but in very large 
doses it gives rise to symptoms in animals similar to those pro- 
duced by iodoform, while its prolonged administration may 
result in fatal fatty degeneration of the internal organs. Its 
surgical use is reported in one instance to have occasioned dizzi- 
ness, marked rise of temperature, vomiting, small irregular 
pulse of 136, albuminuria, and apathy, which continued for 
several days. Iodine was found in the urine for two weeks. 
Experiments have shown that iodol is absorbed quite slowly, 
and to this fact is attributed its greater safety than iodoform 
as a topical application. Locally it appears to have a very 
superficial caustic effect, forming a whitish film on ulcerated 
surfaces, but not a scab. 

Therapeutics of Iodol. 
It may be used for all the same purposes as iodoform, and 
iodol gauze, cotton, ointment, bougies, pastils, etc., correspond- 
ing to those made with iodoform, are now supplied. It is 
largely employed in powder and also in solutions of various 
kinds. That known as Mazzoni's consists of iodol, 1 ; alcohol, 
16; glycerin, 34. An ethereal solution (4 gm. to 30 c.c. ; 1 dr. 
to 1 fl. oz.) has the advantage of leaving the remedy deposited, 
after the evaporation of the ether, in a minutely divided state. 
In ointment (10 per cent.) it has sometimes been substituted 
for the iodine preparations. Painted over and around the 
affected part in a 10 per cent, solution in collodion, it is re- 
ported to have proved successful in aborting erysipelas. Inter- 
nally it has been used in the place of potassium iodide, and it is 
said to be of value in tertiary syphilis, in quantities of from 
0.4 to 2 gm. (6 to 30 gr.) a day. Favorable results are also 
said to have been obtained with it in diabetes. 

Action of Europhen. 
Europhen has considerable value as a local germicide and 
bactericide, and its antiseptic properties, it is thought, depend 
mainly on the fact that it is a phenol derivative, rather than on 



BORON. 83 

its containing iodine. In some respects it differs markedly from 
iodoform and from iodol. Thus, iodine is not liberated by the 
tissues, and, so far as the iodine in it is concerned, europhen 
passes through the body unchanged. It has a specific aromatic 
odor, which is not unpleasant to most persons, and is said to 
be entirely non-toxic. It is incompatible with starch, metallic 
oxides, and the preparations of mercury. 

Therapeutics of Europhen. 
It is used in the treatment of wounds for the other purposes 
for which iodoform is employed, and in the same quantities as 
the latter. It has been found efficacious in burns, chancres and 
syphilitic ulcers and in psoriasis, eczema, lupus and other skin 
affections, as well as in diseases of the nose, throat and ear. 
Mixed with collodion it is applied to buboes. It is largely 
used in ointments of a strength varying from 1 to 10 per cent. 
It has considerable value as a haemostatic, and is regarded as 
especially advantageous whenever a dry antiseptic application 
is required. 

Various other iodoform substitutes (not official) are found in the 
market. The only advantage they have over iodoform is in the mat- 
ter of odor. The principal ones are the following : 

Losophan contains 80.0 per cent, of iodine. 

Di-iodosalicylic acid " 66.0 " 

Sozoiodol " 54.0 " 

Iodosalicylic acid " 50.0 " 

BORON. 

1. ACIDUM BORICUM.— Boric Acid. (Boracic Acid.) Dose, 
0.500 gm. (500 milligm.) ; iy 2 gr. 

Preparations. 

1. Glyceritum Boroglycerini. — Glycerite of Boroglycerin. 
(Solution of Boroglyceride.) 

2. Cataplasma Kaolini. — Cataplasm of Kaolin. 



84 PHARMACOLOGY AND THERAPEUTICS. 

3. Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 
1 fl. dr. 

4. Unguentum Acidi Borici. — Ointment of Boric Acid. 

2. SODII BORAS.— Sodium Borate. (Borax. Sodium Pyroborate.) 
Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Unofficial Preparations. 
Mistura Magnesii Boro-citratis. — Mixture of Magnesium 
Boro-citrate. Dose, 16 c.c.; 4 fl. dr. 

Potassii Tartra-boras. — Potassium Tartra-borate. Dose, 1.20 
gm.; 20 gr. 

Unguentum Boroglycerini. — Boroglycerin (or Boroglyceride). 
Ointment. 

Action of Boric Acid and Borax. 

External. — Experiments have shown that while boric acid 
and borax are inefficient as germicides, they have some antiseptic 
power. The growth of almost all forms of bacilli is arrested by 
a 2^2 per cent, solution, but the microbes are not destroyed, 
and it is stated that even the anthrax bacilli are capable of 
further growth after exposure to a 4 per cent, solution for 
twenty-four hours. They would seem, therefore, to be of ser- 
vice as mild antiseptics, but to be valueless as disinfectants. 
A saturated solution of boric acid in broth will prevent putrefac- 
tion, and this agent is employed to a large extent in the preser- 
vation of milk, meats and other kinds of food. When applied 
in concentrated form to denuded surfaces, it is somewhat 
irritating and mildly astringent; in solution, while slightly 
astringent, it is sedative rather than irritating. Borax has no 
irritant effect. Its alkalinity renders it a cleansing agent of 
some efficiency and also adds to its sedative action. Its pro- 
longed use, as well as that of boric acid, is liable to give rise 
to scaly eruptions of the skin. 

Internal. — Taken in moderate amount borax does not affect 
the digestion and assimilation of food, but larger quantities 
retard the absorption of proteids and fats and increase the bulk 



BORON. 85 

of the faeces. Both borax and boric acid are found to be 
rapidly absorbed by the bowel, and not to affect the intestinal 
putrefaction. Their excretion, which occurs principally by the 
urine, is completed within twenty-four hours. The urine is 
rendered alkaline by borax, if taken in sufficient amounts, as by 
other alkalies; while boric acid, which is excreted in part un- 
changed and in part as borates, increases its acidity. Borax 
seems to be excreted unchanged. Both these substances have 
generally been regarded as having something of a diuretic 
effect, but so far from this being the fact, the latest researches 
go to show that the urine is really diminished in amount under 
their use. Borax is thought by some to have a somewhat stimu- 
lating influence upon the uterus, and is said to have produced 
abortion in certain instances. It is argued, therefore, that it 
cannot be employed with impunity in women. In some cases 
even moderate amounts of boric acid and borax have a mild 
aperient action, while in large doses they are gastro-intestinal 
irritants, and cause vomiting and purging. Other symptoms 
produced by toxic quantities are dryness of the throat and 
dysphagia, profound muscular weakness, lumbar pain and 
vesical tenesmus, with albuminuria and sometimes hematuria, 
dimness of vision, headache, sleeplessness, and nervous depres- 
sion; which may be followed by fatal collapse. A rise of tem- 
perature is frequently observed, and in the course of two or 
three days, if death does not previously occur, eruptions which 
are described as scaly, papular or eczematous, appear upon the 
skin. When the drugs are given by the mouth it is stated that 
nausea, vomiting and diarrhoea appear earlier and are apt to be 
more severe than if they are used in any other way, but the 
same character of symptoms may result from their free applica- 
tion in the rectum, vagina and other parts. They are rapidly 
absorbed from all mucous membranes and from lesions, and a 
number of serious cases of poisoning have been reported from 
the use of boric acid as an antiseptic dressing. In chronic 
poisoning, the condition known as borism, the symptoms are 
often much the same as in cases of acute poisoning. The cu- 



86 PHARMACOLOGY AND THERAPEUTICS. 

taneous manifestations, however, are more prominent, and 
may constitute the only positive indication of toxic action, 
though there are generally evidences of more or less renal and 
gastro-intestinal irritation. (Edema of the face and extremi- 
ties may occur in consequence of the former, and it is advisable 
that whenever these drugs are given in full doses, a careful 
watch should be kept upon the state of the urine. The hair is 
apt to become dry and fall out, and the eruption on the skin 
may assume the form of seborrhceic eczema, reddish patches 
which desquamate like psoriasis, or papules attended with much 
itching. The commonest form of eruption is said to be a scaly 
one, resembling seborrhceic dermatitis, but usually attended 
with much more oedema. In some cases there are marked dry- 
ness of the skin and mucous membranes, with Assuring of the 
lips and striation of the nails, and a blue line, resembling that 
of lead poisoning, has been observed upon the gums. The 
question of the effect of the continued and habitual introduction 
into the body of boric acid or borax, as employed in the preser- 
vation of food, is one of interest. The results of recent careful 
experiments conducted by the Bureau of Chemistry, United 
States Department of Agriculture, show, on the whole, that one 
half gramme (y/ 2 grains) a day is too much for the normal man 
to receive regularly; while on the other hand the normal man 
can receive one half gramme of boric acid, or of borax ex- 
pressed in terms of boric acid, for a limited period of time 
without much danger of impairment of health. The main ob- 
jection to the use, as food preservatives, of these and other 
antiseptics which are harmless in small doses seems to rest 
upon the fraud in permitting inferior goods to be disposed of 
as a first-class article. This applies particularly to meats and 
milk, although the addition of small quantities may sometimes 
be beneficial by delaying the souring of the latter. If larger 
amounts are used for fraudulent purposes, the milk is apt to be 
kept too long and be of inferior quality, while the quantity of 
preservative may be sufficient to prove injurious to infants 
taking it habitually. 



BOROX. 87 

Therapeutics of Boric Acid and Borax. 
External. — These drugs are used to a much greater extent 
externally than internally, and., especially on account of their 
non-irritating qualities, are largely employed as local antiseptics. 
Occasionally they are used in powder. The saturated solution 
of boric acid (4 per cent.) may be applied to wounds, ulcers 
and sores to protect them against infection or decomposition. 
It is efficacious in phlegmonous erysipelas and in a number 
of chronic scaly and parasitic skin eruptions. It is especially 
recommended in the troublesome form of tinea known as 
trichophytosis gcnito-cruralis, which affects the scrotum and 
inner side of the thigh, and it is considered the best remedy for 
fetid perspiration. It is also of service as an injection when 
there are purulent discharges, as in otorrhcea and leucorrhoea, 
and to wash out cavities after operations. The irrigation should 
not be continued too long, however, as toxic symptoms have 
been produced in this way. The same caution applies to wash- 
ing out the large intestine with this solution, which has been 
found of service in colitis ; tannic acid being sometimes added to 
it. Boric solutions, the strength of which may be varied ac- 
cording to circumstances, are very useful in conjunctivitis and 
other inflammations of the mucous membranes, and, applied 
upon lint or absorbent cotton, as a dressing for burns and 
scalds. The Glyceritum Boroglycerini, well diluted, also 
answers well as an antiseptic wash in ophthalmia, ozsena, 
pharyngitis, urethritis, vaginitis, etc.. and likewise for wounds 
and granulating surfaces. For washing out the bladder in cys- 
titis Thompson's fluid (consisting of borax, 1; glycerin, 2; 
water, 2), diluted with eight times as much water, is commonly 
employed; and one of the most important antiseptic solutions 
is that of Thiersch, consisting of boric acid. 12 ; salicylic 
acid, 2; water, 1000. The glycerin of the B. P., which is 
borax, 1 ; water, 2 ; glycerin, 4, and the honey of borax of the 
B. P. (which is borax, 2; glycerin, 1; clarified honey, 16), are 
much used in aphthous sore mouth. This is also often treated by 
the application of borax mixed with powdered sugar. The 



88 PHARMACOLOGY AND THERAPEUTICS. 

following is an excellent mouth-wash: Glycerin of borax 
(B. P.), 6; tincture of myrrh, i; water, to 48. For sunburn, 
pruritis and other skin affections, as well as for wounds, ulcers, 
etc., boric acid ointments such as the official one will often be 
found serviceable. The ointment of the B. P. consists of boric 
acid, 1; paraffin ointment (soft paraffin, 3; hard paraffin, 7; 
melted together), 9. Lister's ointment consists of boric acid, 1; 
white wax, 1 ; paraffin, 2 ; almond oil, 2. An ointment of boro- 
glyceride (not official) is made of glycerin, 92; boric acid, 62; 
by heating. Greene's ointment is prepared by melting one part 
each of spermaceti and white wax with six parts of vaselin, and 
adding, while hot, two to four parts of a saturated glycerite of 
boric acid. For application to extensive burns it would be ad- 
visable to dilute most of these ointments. Boric lint and boric 
cotton, made by steeping the materials in a saturated solution of 
boric acid at the boiling-point, are used to a considerable extent 
in surgery, gynaecology, etc. The external use, as well as the 
internal administration, of boric acid and the borates should be 
employed with caution when disease of the kidneys is present. 
Boric acid may be used to preserve solutions intended for hypo- 
dermatic use. 

Internal. — Internally boric acid is almost exclusively given 
for correcting the fetor of fermentative dyspepsia and in cases 
of cystitis with decomposing urine, where it is also used in 
solution for irrigation of the bladder. In ammoniacal cystitis 
it tends to render the urine acid (probably by checking the fer- 
mentation, and also because it is excreted in part as boric acid), 
and has a beneficial effect upon the vesical mucous membrane. 
It should be given in full doses, in diluted watery solution, and 
its administration should occasionally be suspended. Borax is 
sometimes of service in relieving irritability of the bladder. 
Although at one time several observers reported beneficial ef- 
fects from the use of the latter drug in typhoid fever, the treat- 
ment never won the confidence of the profession, and has been 
practically abandoned. It has been tried to a considerable ex- 
tent in epilepsy, but for the most part with disappointing re- 



POTASSIUM PERMANGANATE. 89 

suits. While far less efficient than the bromides., it is, in the 
quantity in which it is required to produce any effect in this 
disease, much more dangerous. It is said to be apparently of 
most service in cases where these agents fail and in those in 
which the epilepsy is associated with gross organic disease. 
Among the other conditions in which it has been employed are 
dysmenorrhea, amenorrhea and uterine haemorrhage, as well 
as inertia of the uterus during labor. It is sometimes taken 
in very large doses for the purpose of criminally causing abor- 
tion. That it really has any action on the uterus would seem 
to be problematical. It is thought by some to be of value as 
a solvent for uric acid calculi; but here again grave doubts 
have been expressed as to its efficacy. Another boric acid salt, 
magnesium borocitrate, has also been strongly urged for this 
purpose, but in the opinion of other authorities potassium tartra- 
borate is preferable, on the ground that the potash compounds 
of uric acid are more soluble than the soda compounds. It is 
obtained by heating together until dissolved 4 parts of potas- 
sium bitartrate, 1 part of boric acid, and ten parts of water. 
The solution is then evaporated to dryness and the residue 
powdered. 1.20 gm. (20 gr.) should be given three or four 
times a day in a large quantity of water. The unpleasant taste 
of borax may be covered with liquorice, or. preferably, with 
syrup of orange-peel. 

POTASSIUM PERMANGANATE. 

POTASSI PEEMANGANAS.— Potassium Permanganate. Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Action of Potassium Permanganate. 
External. — Kept dry. it is a permanent salt, but in the presence 
of moisture it rapidly gives up its oxygen and is converted into 
manganese dioxide. In powder it has some effect on living 
tissues, and acts as a mild caustic. In concentrated solutions 
it causes irritation and even corrosion of the skin. When a 
solution comes in contact with proteids. such as albumin, it 



90 PHARMACOLOGY AND THERAPEUTICS. 

at once parts with some of the oxygen which it contains, and 
the latter unites with the albumin. It is therefore a powerful 
oxidizing agent and, in consequence, is poisonous to proto- 
plasm. It has very considerable germicidal activity, but this 
is short-lived for the reason that it so quickly parts with its 
oxygen; after which it becomes inert. Experiment has shown 
that 0.12 per cent, (i part in 833) will destroy the micrococci 
of pus in two hours. Except in very superficial infection, 
however, its antiseptic value is smaller than that of many 
other agents, since, on account of the rapidity of its reduction, 
it fails to penetrate deeply, and its action is limited to the skin 
and the surface of the mucous membranes. Within a limited 
sphere it is a very efficient disinfectant and deodorant. 

Internal. — It is not absorbed in sufficient amount to have any 
general action. When taken in poisonous quantities, the re- 
sulting phenomena are entirely local. This local action is 
manifested in gastro-enteritis and irritation or inflammation 
of the kidneys. The lack of general action, according to some 
authorities, holds true even when it is introduced into the 
circulation by subcutaneous or intravenous injection. Accord- 
ing to others, in acute poisoning the blood-pressure falls, from 
depression and paralysis of the vaso-motor centre, while the 
heart is not affected until much later. Injected thus into the 
circulation, it is excreted principally by the intestinal epithe- 
lium and to a smaller extent by the kidneys. When taken by 
the mouth, very little appears to be absorbed from the stomach 
and intestines. In the mouth weak solutions of potassium per- 
manganate have a sweetish but astringent and unpleasant taste, 
and there, as well as in the stomach, it is quickly reduced to 
the dioxide and loses its oxidizing power. On account of its 
caustic action this remedy, when taken in the form of pills or 
tablets, sometimes occasions considerable gastric irritation and 
pains. In the blood of man and animals traces of manganese 
are very frequently found, but it has been shown that this 
metal is not an essential constituent of the body; being appar- 
ently absorbed accidentally with the food. The theory that 



POTASSIUM PERMANGANATE. 9 I 

manganese salts could replace iron in the body has been proved 
to be untenable. 

Therapeutics of Potassium Permanganate. 
External. — One objection to its use, when large quantities are 
required, is its expensiveness. Another objection is that it 
stains fabrics. The stain may be removed by the application 
of sulphurous acid, but as this results in the formation of sul- 
phuric acid, the fabric should be promptly rinsed in water. As 
an antiseptic it may be used to wash wounds, sores and ulcers 
in a solution of the strength of 4 gm. (1 dr.) to 500 c.c. 
(1 pint). For application to mucous membranes, as in a 
gargle or lotion for swabbing the throat in diphtheria, scarlet 
fever, and other diseases, the proportion should be about 1.20 
gm. (20 gr.) to 500 c.c. (1 pint). Such solutions are em- 
ployed in necrosis of the jaw, cancer of the tongue, and gener- 
ally in affections causing foul breath. They are useful also 
for correcting fetor in various other conditions, such as ozaena, 
bromidrosis of the feet, etc. Solutions of the strength of .06 to 
.26 gm. (1 to 4 gr.) to 500 c.c. (1 pint) may be employed as 
injections for gonorrhoea and leucorrhcea, and for washing out 
the stomach, bladder, uterus, abscess cavities, etc. One ad- 
vantage connected with the use of potassium permanganate in 
this way is that it can be readily seen when it has lost its 
efficiency by the change in the color of its solutions. As soon 
as it has become reduced to the dioxide, by giving up its oxygen, 
these turn dark brown, and so long therefore as such injections 
return with their pink color retained, the assurance may be 
felt that the parts are being properly cleansed. It is asserted 
that potassium permanganate, owing to its properties as an 
oxidizing agent, is the most efficient antidote to snake-venom, 
if placed in the wound before the poison is absorbed. It is also 
recommended that it should be injected subcutaneously about 
the seat of the bite. As a local application in erysipelas its 
solutions have been found beneficial. As a deodorizer for 
sputa, stools, drains, etc., and for washing utensils it is used 



92 PHARMACOLOGY AND THERAPEUTICS. 

in the proportion of about i to 150. The Liquor Potassi Per- 
manganatis of the B. P. contains 1 part of the permanganate 
to 100 of distilled water, and Condy's fluid is a solution of 50 
gm. (8 gr.) in 30 c.c. (1 fl. oz.) of distilled water. Potassium 
permanganate is one of the best known disinfectants for the 
hands. They should be washed in its saturated solution, which 
stains them a deep purple, and immediately decolorized with 
a saturated solution of oxalic acid. 

Internal. — On account of its disagreeable taste, potassium 
permanganate should preferably be given in the form of pills 
or compressed tablets. As many substances tend to reduce it, 
it is considered best that the pills should be made with kaolin 
and soft paraffin, but cacao butter and rosin cerate are also 
used as excipients. For the dyspepsia and flatulence which so 
constantly accompany excessive fat, and also for the reduction 
of the obesity itself, the permanganate is a remedy of consider- 
able value. It often affords relief to patients suffering from 
lithaemic conditions, with pain in the lumbar region and intesti- 
nal indigestion, associated with frequent micturition, acid urine, 
and much brick-dust sediment ; while it favors the conversion of 
uric acid into urea, and thus tends to prevent the formation of 
uric acid calculi. On account of its oxidizing properties it is 
also sometimes of service in acute rheumatism. Potassium per- 
manganate has been much extolled as an emmenagogue, but in 
the large doses in which it is advised for this purpose (12 to 30 
gm. ; 2 to 5 gr.), it is almost certain to create gastric disturb- 
ance. Very few stomachs will tolerate more than one grain of 
the salt, and the dose given for the B. P. solution, which is 
equivalent to from 1.2 to 2.4 grains, is therefore rather large 
for most persons. As it is in fact reduced in the stomach to 
the dioxide, tha't salt is preferable in amenorrhcea. If manga- 
nese is of any use in anaemia, which has not yet been proven, it 
probably acts in the same way as iron. The iron-manganese 
preparations, so much lauded, owe their efficiency, if they pos- 
sess any, to the iron which they contain in varying amounts. 
Potassium permanganate oxidizes morphine, and is therefore 



HYDROGEN DIOXIDE. 93 

an antidote to morphine poisoning. About two grains in solu- 
tion should be given for each grain (estimated) of morphine 
swallowed, and the stomach should be immediately and re- 
peatedly washed out with repetitions of the antidote. It has 
been shown that during the acute stage of morphine poisoning 
there is a continuous excretion from the walls of the stomach 
of the morphine, which is subsequently reabsorbed either from 
the stomach or the intestine. Potassium permanganate has 
also been recommended, internally as well as locally, in snake- 
bite and erysipelas, and in septicaemia and puerperal fever. 

HYDROGEN DIOXIDE. 

AQUA HYDROGENII DIOXIDL— Solution of Hydrogen Dioxide. 
(Solution of Hydrogen Peroxide.) Dose, 4 C.C.; 1 fl. dr. 

Action of Hydrogen Dioxide. 
Hydrogen dioxide readily yields oxygen to all oxidizable 
substances. When taken internally it gives oxygen to the blood, 
stimulates the nervous system, and increases urinary secretion. 
In the blood the oxygen set free may cause the formation of 
emboli and lead to serious consequences. A death is recorded 
in which the fatal result is thought to have been due to this 
cause (the solution of hydrogen dioxide having been employed 
to wash out the pleural cavity) ; and in several instances 
hemiplegia is said to have been observed, apparently from em- 
bolism of the cerebral arteries. The different organs and tissues 
have been found to vary considerably in their power of causing 
the catalytic decomposition of the dioxide, the red corpuscles 
of the blood and the liver cells being the most active, and it is 
now believed that this action of the tissue cells is closely asso- 
ciated with the presence of nucleo-proteids, and not with fer- 
ment action, as formerly held. It is a non-poisonous and 
powerful antiseptic. It decomposes pus and probably destroys 
the microbes of suppuration. Its antiseptic activity is of com- 
paratively short duration, however, ending as soon as all the 
oxygen is liberated. 



94 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Hydrogen Dioxide. 
Hydrogen dioxide seems to have a favorable action in some 
forms of dyspepsia, and to improve digestion. In diphtheria it 
is useful as a cleansing agent and for absorbing false mem- 
branes, but should be used in glass or hard rubber instruments. 
Some commercial preparations are very acid, and therefore too 
irritating for this purpose. This acidity may be neutralized by 
adding twice its quantity of lime water. It will check bleed- 
ing, but from small vessels only. It is of great value in cleans- 
ing wounds, ulcers and fistulous tracts, and for surgical dress- 
ings ; the cessation of frothing indicates the destruction of pus. 
But the converse of this is not true, for it will froth with 
perfectly normal blood. It should not be injected into a sup- 
purating cavity unless there is a free outlet for the escape of 
the gas which is formed. Its most popular use is for bleach- 
ing the hair, and in hirsuties it has been found to retard the 
growth of hair. It is employed to a considerable extent as an 
injection in gonorrhoea on account of its activity in destroying 
the gonococcus and arresting the formation of pus. It is also 
useful in the treatment of leucorrhoea, otorrhoea, ozsena, 
tonsillitis, chancre, etc., and has proved of service as an irri- 
gating agent in ulcerative blepharitis, purulent conjunctivitis, 
granular conjunctivitis, and other eye affections. A useful ap- 
plication of the dioxide is in the treatment of gunpowder burns, 
in which it is stated to absolutely remove the black stain which 
ordinarily remains permanently. The solution (U. S. P.) 
should be applied on the first or second day after the burn, and 
in such a way that it may get thoroughly into the centre of 
each pigment spot. It is necessary to prick each point well 
open, when the bubbling resulting from the use of the dioxide 
will remove the inorganic remains of the powder. Hydrogen 
dioxide has been highly recommended as a local anaesthetic. 
Injected under the epidermis it is claimed that it produces imme- 
diate and complete analgesia of the whole skin, and it is stated 
to have been used successfully in this way in opening abscesses, 
cutting off redundant tissue in ingrowing toe-nails, in opening 



CHARCOAL. 95 

the pleural cavity, and even in performing laparotomy. It 
is a well-recognized fact that a small amount of the solution, 
poured over the closely adhering dressing of a wound, will 
not only relieve the pain incident to the removal of the dress- 
ing, but also alleviate any irritation that may be set up. Good 
results have been reported from the use of the vapor of hydro- 
gen dioxide in the treatment of whooping-cough. A solution 
of the strength of 12 volumes is employed, and of this 80 gm. 
(3 oz.) is poured upon a linen cloth about three feet square, 
which is suspended in the room occupied by the patient. It is 
advised that two small rooms should be*used, one for the day 
and one for the night, and that the solution should be replen- 
ished every four hours. Internal treatment may be given at 
the same time. In cases of persistent vomiting repeated sips 
of a weak solution sometimes prove efficient. The claims that 
have been brought forward for the utility of hydrogen dioxide 
in low fevers, epilepsy, diabetes, uraemia and other grave con- 
stitutional states have never been substantiated, and it appears 
to possess no distinct value in internal medication. Its use by 
hypodermatic injection is attended with special risk, on account 
of the liability to the formation of emboli, which may either 
plug up the cerebral arteries or, lodging in the lungs, produce 
fatal asphyxia. 

CHARCOAL. 

1. CARBO ANIMALIS.— Animal Charcoal. 

2. CARBO ANIMALIS PURIFICATUS.— Purified Animal Char- 
coal. 

3. CARBO LIGNL— Charcoal. (Wood Charcoal.) Dose, 1 gm.; 
15 gr. 

Action of Charcoal. 
External. — Charcoal is an oxidizing agent and a deodorant. 
Owing to its porous character, it is an active absorbent of gases, 
which become condensed in its interstices. It thus ordinarily 
contains oxygen in large amount, being capable of absorbing 
eighteen times its own volume of this substance. The latter, in 



96 PHARMACOLOGY AND THERAPEUTICS. 

consequence apparently, of its condensed state, is possessed of 
special activity. When, therefore, charcoal is brought into con- 
tact with decomposing organic matter, it absorbs the gases, 
which of itself tends to remove the foul odor, while the oxygen 
effects the oxidation of the matter to its simplest combinations. 
Charcoal possesses the property of absorbing, in addition to 
gases, many colloid bodies, such as the coloring matter of plants 
and proteids, and has the power of oxidizing organic matters in 
solution or in the solid form. It appears to act when moist 
almost as efficiently as in the dry state, as is shown by its ac- 
tivity in oxidizing organic impurities in water when charcoal 
filters are used. In time its power of oxidation becomes ex- 
hausted, the rapidity with which this takes place depending 
upon the amount of organic matter with which it comes in 
contact; but this may be restored by heating the charcoal to 
redness. It is incorrect to speak of charcoal as a disinfectant 
(though it is popularly regarded in this light), as it is not ger- 
micidal or antiseptic, having no influence upon living organisms. 

Internal. — Charcoal is altogether inert, as regards any effect 
upon the system, except in so far as by reason of its absorbent 
and oxidizing properties it may check meteorism and flatulence. 
By its mechanical action on the intestinal walls it sometimes 
serves, when taken in large doses, as a mild laxative, and also 
has some effect in clearing away mucus. It passes through 
the alimentary canal unabsorbed, and is found unchanged in 
the faeces. 

Therapeutics of Charcoal. 

External. — Charcoal makes a cheap and efficient deodorant 
and absorbent application to cancerous sores with offensive dis- 
charges, foul ulcers, gangrenous wounds, etc. As, however, 
large quantities are required and as it is very dirty, ordinary 
antiseptic and disinfectant dressings will generally be found 
more serviceable in such conditions. It may be used as a 
powder, made into a thin paste with water, or mixed with 
poultices. The most cleanly way of employing it is in thin bags 
of fine texture. Charcoal is sometimes used as a tooth-powder, 



CHARCOAL. 9/ 

but it should not be recommended, because it abrades the enamel 
of the teeth and discolors the gums. In pharmacy it is useful as 
a decolorizing agent and for filtering; but charcoal niters are 
objectionable in the household because unless renewed very 
frequently they not only lose their virtues but may become 
breeding-places for infectious germs. 

Internal. — It is most conveniently administered in tablets or 
capsules, but is sometimes given mixed with water. In some 
cases charcoal biscuits are preferred. Among the conditions 
in which it has been found of sen-ice are the following : Decom- 
position of the contents of the stomach, flatulent dyspepsia at- 
tended with fetid breath, gastralgia, acidity, heartburn or foul 
eructations, intestinal indigestion with meteorism, diarrhoea, 
dysentery, and ulceration of the intestines with foul stools. In 
choleriform diarrhoea, both in adults and children, finely 
powdered charcoal, given in milk diluted with water and 
sweetened, has been found efficient, and in epidemic dysentery 
good results have been obtained from the remedy, administered 
both by the mouth and the rectum. In some instances it 
answers well in the vomiting of pregnancy. Large doses, when 
not accompanied with a sufficient amount of water, have been 
known to cause intestinal obstruction. In view of the fact that 
charcoal has the power of removing alkaloids from solutions, 
it has been recommended in diseased conditions resulting from 
the formation in the alimentary canal of toxins and ptomaines 
of an alkaloidal nature. It is also said to be sometimes useful 
as an antidote in poisoning by phosphorus and by such alkaloids 
as morphine and strychnine, by removing the toxic agent from 
solution. Purified animal charcoal is preferred for this pur- 
pose, and it is advised that after its use the stomach should be 
evacuated by the stomach-pump or emetics. It is stated that 
15 gm. (y 2 oz.) of the charcoal, which should be rubbed up 
with sufficient water to make a thin liquid, will render inert 
about .06 gm. (1 gr.) of alkaloid. 



98 PHARMACOLOGY AND THERAPEUTICS. 

SULPHUR. 

1. SULPHUR SUBLIMATUM.— Sublimed Sulphur. (Flowers of 
Sulphur.) Dose, 4 gm.; 60 gr. 

2. SULPHUR PR^CIPITATUM.— Precipitated Sulphur. (Lac 
Sulphuris — Milk of Sulphur.) Dose, 4 gm.; 60 gr. 

3. SULPHUR LOTUM.— Washed Sulphur. Dose, 4 gm.; 60 gr. 

Preparation. 
Unguentum Sulphuris. — Sulphur Ointment. 

Action of Sulphur. 
External. — Sulphur is itself entirely inert, and whatever 
effects it has upon the system, whether internal or external, are 
due to the agency of sulphides resulting from solution in the 
secretions and of hydrosulphuric acid (H 2 S), or hydrogen sul- 
phide. The sulphides, being weak salts, readily yield them- 
selves to the formation of the free acid. Although they them- 
selves no doubt have some irritant action, in addition to that of 
the latter, hydrogen sulphide differs from them in being an 
acid, with extremely marked irritant properties, and also in 
being a gas (sulphuretted hydrogen). It is a very powerful 
poison, which even in small amount is destructive to most forms 
of life. Thus it has been found that the microbes of putrefac- 
tion, which produce it themselves, are eventually killed by it, 
unless it escapes freely. Its toxic effects on the system are 
due in part to its local irritation and in part to direct action on 
the brain and medulla. When inhaled in concentrated form it 
produces death almost instantly, and a very dilute vapor of it 
induces irritation of the eyes, nose and throat and a reflex in- 
crease in the secretion of tears, saliva and mucus. Upon the 
skin and mucous membranes sulphur has a stimulant, irritant 
effect and also a parasiticidal and antiseptic action. The con- 
version of free sulphur into sulphides is ordinarily a somewhat 
slow process, and as it can exert any influence only in propor- 
tion to the extent to which such conversion takes place, the 
irritation produced by it is apt to be mild and prolonged. This, 



SULPHUR. 99 

it has been pointed out, is the secret of its therapeutic success. 
Applied to skin already inflamed, however, it is apt to act as 
a severe irritant, and to raw surfaces, such as wounds and 
ulcers, as a powerful caustic. The sulphides, in contact with 
the skin, have a solvent action upon the horny epidermis and 
the hair. Absorption may take place from the cutaneous sur- 
face, as well as the alimentary canal. 

Internal. — When sulphur is taken by the mouth, much the 
larger portion of it passes without change through the ali- 
mentary canal, and is so discharged in the faeces. The re- 
mainder is converted by the alkaline fluids of the intestine into 
sulphides, which form some hydrogen sulphide and, after being 
absorbed into the blood, are oxidized rapidly and excreted 
principally by the urine, as sulphates and in obscure organic 
combination. In some instances experiment has shown the 
urea in the urine to be considerably increased, but whether the 
nitrogenous waste is as a rule augmented by the sulphides has 
not as yet been determined. A small amount of the converted 
sulphur is excreted by the lungs, in consequence of which the 
characteristic odor of hydrogen sulphide may be imparted to 
the breath. The sulphur compounds, by reason of their irri- 
tant effect, act locally upon the intestine, causing increased 
peristalsis and mild purgation, with soft stools and but little 
griping, They also have an antiseptic action in the intestines. 
Under large doses of sulphur the symptoms of intestinal irrita- 
tion may be more severe than those mentioned, the evacuations 
assuming a bloody character. The drug has a slight diaphoretic 
action, the cutaneous secretions being stimulated to some extent 
during its elimination. Hydrogen sulphide is excreted in 
minute amount by the skin (so that silver articles about the 
persons of those taking sulphur may be discolored), and also in 
the milk of nursing women. When injected intravenously in 
mammals the sulphides induce violent convulsions, which are 
apparently of cerebral origin, since it has been shown that they 
do not occur in the hind limbs after section of the spinal cord. 
Their action on the blood is to reduce the oxyhemoglobin and 



IOO PHARMACOLOGY AND THERAPEUTICS. 

so diminish the processes of oxidation, while at the same time 
there is formed a compound known as sulpho-methaemoglobin or 
as sulpho-haemoglobin, which is considered more nearly related 
to methaemoglobin than to haemoglobin. The blood changes 
were formerly supposed to be the cause of death in poisoning, 
but it is now known that this is owing to direct action on the 
central nervous system. The respiration, which is at first ac- 
celerated, later becomes dyspnceic and finally ceases; the fatal 
result being due to this, together with the paralysis of the 
vasomotor centre. The heart is apparently affected only indi- 
rectly through the failure of respiration and the fall of blood- 
pressure. While the effects of sulphur are due entirely to the 
action of the sulphides and hydrogen sulphide into which it is 
changed in the intestine, therapeutically it is never given in 
sufficient amounts to elicit the toxic action of these agents upon 
the system. Clinically, advantage is taken of its especial ten- 
dency to act upon the skin and mucous membranes. 

Therapeutics of Sulphur. 
External. — Inunction with sulphur has always been considered 
the typical remedy for scabies, but at the present time balsam 
of Peru, which makes an efficient and much more agreeable 
application, is used to a considerable extent in its stead. The 
sulphur treatment should be inaugurated with a warm bath 
lasting about twenty minutes, after which the patient should 
be scrubbed all over, with the exception of the head and face, 
with soft soap or potash, for the purpose of breaking open the 
furrows and exposing the acari or itch-insects. Next the sur- 
face should be rinsed with clean water and dried, and then sul- 
phur ointment should be thoroughly rubbed in with friction. 
The official ointment in full strength sometimes gives rise to 
an erythematous or papular, eczematous or pustular, eruption, 
and it is therefore generally well to dilute it. The following 
application may be used: Oil of cade, 4 c.c. (1 fl. dr.) ; sulphur 
ointment, 8 gm. (2 dr.) ; lanolin, 19.5 gm. (5 dr.). The patient 
should then go to bed, sleeping in flannel, and the next morn- 



SULPHUR. 10 1 

ing should wash himself clean and put on clean underclothing. 
One such application is generally sufficient to effect a cure, but 
it may be repeated once or twice. In order to prevent reinfec- 
tion by the parasite, the bed linen and the clothing previously 
worn should either be destroyed or disinfected by baking or 
thorough boiling. Sulphur is also employed for pediculosis and 
the various forms of tinea, as well as chronic acne, rosacea, 
eczema, psoriasis, and other skin diseases. In acne of the face it 
should be used with caution, especially if the sebaceous follicles 
are in a patulous condition, as the sulphur, getting into their 
openings, is liable to cause black points. Many of the parasitic 
affections are best treated by means of sulphur-vapor baths, 
and potassium sulphide baths are useful in syphilis. Insuffla- 
tions of powdered sulphur are sometimes made into the throat 
or nose in diphtheria, scarlet fever, and other infectious dis- 
eases, and ointments containing sulphur have been applied to 
the skin in scarlet fever, measles, small-pox and erysipelas. In 
alopecia circumscripta sulphur is sometimes of service in pro- 
moting the growth of the hair. Associated with live steam, 
the fumes of burning sulphur may be relied upon to disinfect 
rooms, ships, etc. Moisture is essential for the success of the 
process. {See Sulphurous Acid.) 

Internal. — The continued use of small doses of sulphur may 
prove useful in such affections as acne, sycosis, psoriasis and 
chronic eczema, and especially when the upper layer of the skin 
and the glands are affected, as well as in loss of hair and dis- 
eased conditions of the nails. It is a very good laxative, espe- 
cially for children, and washed sulphur is one of the ingredients 
of the popular compound liquorice powder {see Senna). The 
sulphur lozenge of the B. P. contains .30 gm. (5 gr.) of pre- 
cipitated sulphur and .06 gm. (1 gr.) of acid potassium tartrate, 
and one or two of these at night generally answers very well 
in cases of mild constipation. On account of its lack of griping 
and the softness of the stools it causes, sulphur is very useful 
in piles, fistula and other rectal affections, and as a laxative 
after operations upon the pelvic organs. It is also thought to 



102 PHARMACOLOGY AND THERAPEUTICS. 

be of service in disordered conditions of the liver, for which 
the various mineral waters containing sulphur and its salts 
may likewise prove beneficial. Such waters, as for instance 
those of Richfield Springs, are useful for chronic rheumatism, 
as well as for chronic sore throat, bronchitis, etc., especially 
associated with digestive difficulties or a gouty or rheumatic 
diathesis, and for lead poisoning and various skin diseases, in- 
cluding the late secondary eruptions of syphilis. They are used 
both internally and in baths. 

4. SODII SULPHIS.— Sodium Sulphite. Dose, 1 gm.; 15 gr. 

5. SODII BISULPHIS.— Sodium Bisulphite. Dose, 0.500 gm. (500 
milligm.) ; 7 y 2 SX- 

6. SODII THIOSTJLPHAS (Sodii Hyposulphis, U. S. P., 1890).— 
Sodium Thiosulphate. (Sodium Hyposulphite.) Dose, 1 gm.; 15 gr. 

Unofficial Preparation. 
Potassii Sulphis. — Potassium Sulphide. 

Action of Sodium Sulphite, Bisulphite and 
Thiosulphate. 
They tend to arrest putrefaction and other forms of fermen- 
tation, being moderately powerful antiseptics for the reason 
that they withdraw oxygen from organic matter in order to 
oxidize themselves to sulphates. Injected into animals they 
have a decidedly toxic effect. In frogs they produce paralysis 
of the central nervous system (commencing in the brain and 
descending to the spinal cord), and of the muscles and periph- 
eral nerve endings, and the heart comes to a standstill in 
diastole. In mammals the action is exerted chiefly upon the 
medulla oblongata and the heart, and the respiration fails a 
little before the latter. As they are slowly absorbed from the 
alimentary canal, and a portion is changed to the harmless 
sulphate before reaching the blood, much larger quantities are 
required to poison animals by the mouth than by subcutaneous 
injection. Large doses of sulphite have been taken by man 



SULPHUR. 103 

without the production of toxic symptoms, but most of the prep- 
arations are said to contain a very considerable amount of sul- 
phate. In some instances comparatively small quantities have 
given rise to more or less gastro-intestinal irritation. As it 
has been found that even small doses, when given daily to 
animals, cause haemorrhages in different parts of the body, the 
use of these salts for the purpose of preserving wines, meats, 
etc., should be condemned. 

Therapeutics of Sodium Sulphite, Bisulphite and 
Thiosulphate. 
Their therapeutic application is of somewhat limited range. 
Sodium sulphite, in the form of a wash (4 gm. ; 1 dr. to 30 c.c. ; 
1 fl. oz.) is of service in aphthous sore mouth, and has also 
been locally used for various parasitic skin diseases. It may 
be given with advantage in some forms of gastric fermentation, 
and is especially useful in yeasty vomitings where the sulphurous 
acid liberated from the salt in the stomach by the acid of the 
yeasty matter has the effect of destroying the microscopic fungi 
present (sarcina ventriculi and torula cerevisicz) . It was be- 
lieved at one time that the sulphites would prove highly efficient 
in pyaemia and various zymotic diseases, from their supposed 
action as antiseptics in the blood; but the hopes thus entertained 
have proved entirely fallacious. Atomized solution of sodium 
sulphite or thiosulphate may be inhaled in gangrene of the lung, 
fetid bronchitis, etc. Locally applied, in a solution of 2 gm. 
(30 gr.) to 30 c.c. (1 fl. oz), the thiosulphate is useful in poison- 
ing from Rhus toxicodendron and in pruritus from other causes. 
This salt, in doses of from .60 to 2 gm. (10 to 30 gr.) every four 
hours, is also said to be of value in malarial haematuria. 

7. CALX SULPHURATA.— Sulphurated Lime. (Crude Calcium 
Sulphide.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

8. SULPHURIS IODIDUM.— Sulphur Iodide. 

Unofficial Preparation. 
Potassa Sulphurata (U. S. P., 1890). — Sulphurated Potassa. 
(Liver of Sulphur.) 



104 PHARMACOLOGY AND THERAPEUTICS. 

Action of Sulphurated Potash, Sulphurated Lime, and 

Sulphur Iodide. 
External. — These preparations are irritant, and are powerful 
parasiticides. The local action of sulphur iodide resembles that 
of iodine, and when diluted it is a stimulant to the glands of 
the skin and aids the absorption of inflammatory exudation. 

Internal. — Sulphurated lime is less irritant than sulphurated 
potash, and small doses may cause a sensation of warmth at the 
epigastrium and also have a slight laxative effect. Both of 
these substances in large doses excite gastro-enteritis. In the 
case of the potash preparation, considerable hydrogen sulphide 
is formed from its decomposition in the alimentary canal, and 
the absorption of this may produce poisoning so severe as to 
cause death in a short time. Small doses act in a similar man- 
ner to sulphur, but occasion more local irritation. Sulphurated 
lime is believed to have a special influence in preventing or 
limiting suppuration. The action of sulphur iodide is essentially 
that of iodine, the proportion of sulphur not being sufficient to 
produce any effect in the small doses in which alone it can be 
given. 

Therapeutics of Sulphurated Potash, Sulphurated Lime, 
and Sulphur Iodide. 
External. — Scabies may be cured by ointments made with 
either of these substances, and a weak sulphurated potash oint- 
ment (.30 to 1.20 gm. ; 5 to 20 gr., to 30 gm. ; 1 oz.) is used 
to some extent for this purpose. The alkalinity of the drug- 
assists in penetrating the epidermis, but renders the applica- 
tion more or less irritating; so that if it is employed after the 
skin has been softened by a warm bath it may excite a trouble- 
some eczema. In the treatment of scabies, Vleminckx's solu- 
tion, which is made by boiling 165 parts of freshly slaked lime 
with 250 parts of sublimed sulphur in water, sufficient to make 
1000 parts, and the active agent of which is calcium penta- 
sulphide, is sometimes preferred to an ointment. It should be 
applied with a somewhat stiff brush or a piece of lint. Oint- 



SULPHUR. 105 

ments containing 2 gm. (30 gr.) of sulphurated potash to 30 gm. 
(1 oz.) are used with benefit in rosacea and acne indurata, but 
care should be taken that they are applied to the affected parts 
only. Chronic eczema and psoriasis are sometimes treated with 
warm baths made with sulphurated potash, 1 ; water, 960, in 
imitation of the natural sulphide waters, such as those of Aix- 
la-Chapelle, as are also various forms of chronic rheumatic 
trouble. Calcium sulphide may be used as a depilatory, in the 
form of a paste made by passing hydrogen sulphide into a 
thick milky mixture of lime and water, but is less satisfactory 
than barium sulphide. An ointment of sulphur iodide, of the 
strength of 2 gm. (30 gr.) to 30 gm. (1 oz.), is useful in ring- 
worm and other parasitic skin diseases, as well as in lupus vul- 
garis and other forms of cutaneous tuberculosis and in rosacea 
and acne indurata. If there is much irritation present, it 
should be used in greater dilution. An objection to the oint- 
ment is its tendency to speedy decomposition. 

Internal. — Sulphurated potash and sulphur iodide are rarely 
given internally. In order to obtain the effects of sulphurated 
lime on the process of suppuration the dose should be repeated at 
very frequent intervals. It is useful in the prevention and treat- 
ment of styes, boils, carbuncles, abscesses, etc. It has also been 
used with advantage in acne, ezcema, ophthalmia and sores in 
scrofulous children, the suppuration of tuberculous glands, and 
acute tonsillitis, especially in strumous patients; and one case 
of elephantiasis is recorded in which it was successfully em- 
ployed. The natural sulphide waters, such as those of the Blue 
Lick Springs of Kentucky, which are said to be almost identical 
with the well known Harrowgate water of England, are bene- 
ficial in habitual constipation from deficient intestinal secretion, 
and in obesity, engorgement of the pelvic viscera in women, and 
haemorrhoids in both sexes, when dependent upon torpid portal 
circulation. Their prolonged use has also been attended with 
good effects in glandular affections, hepatic, splenic, prostatic, 
etc. They should be discontinued when anaemia is threatened, 
and if given at all in anaemic subjects should be associated with 



106 PHARMACOLOGY AND THERAPEUTICS. 

suitable tonic treatment. In France sulphur iodide is asserted 
to have proved of great service in human glanders. 

9. ACIDUM SULPHUROSUM.— Sulphurous Acid. Dose, 2 c.c; 
30 m,. 

Action of Sulphurous Acid. 

External. — Sulphurous acid is characterized by its strong 
affinity for oxygen and is a disinfectant, deodorizer and para- 
siticide. Through its powerful reducing action it becomes 
oxidized to sulphuric acid, and is rendered highly poisonous, 
(independently of its acidity), to parasitic organisms, especially 
those of a vegetable character. By it the activity of unformed 
ferments is also abolished or diminished. Thus, it has been 
found that i part in 1300 will arrest the action of pepsin, 1 in 
8600 that of ptyalin and diastase, and 1 in 20,000 that of myrosin 
and emulsin. The official solution has no effect upon the 
unbroken skin, but is more irritant to raw surfaces than many 
other equally powerful antiseptics. It is also strongly irritant 
to mucous membranes. 

Internal, — In concentrated form sulphur dioxide is entirely 
irrespirable, causing spasm of the glottis. Even when inhaled 
in the strength of 5 parts in 10,000 the gas is decidedly irritant 
to the respiratory mucous membrane, and when a little less 
diluted excites catarrhal inflammation of the tract. It pene- 
trates the tissues more rapidly than most other mineral acids. 
In solution it has the same irritant action on the mucous mem- 
branes as others of equivalent strength, while upon the contents 
of the stomach it has an antiseptic effect and also interferes 
with the action of the digestive ferments. It is excreted by 
the kidneys and alimentary canal in the form of sulphates, to 
which it is oxidized during absorption and in the tissues. The 
sulphites are said to be capable of causing death by paralyzing 
the heart, as well as the respiratory and other motor nerve- 
centres, but are so rapidly and completely changed into sul- 
phates that unless given in enormous amount they are found to 
exert very little influence upon the system. 



SULPHUR. I07 

Therapeutics of Sulphurous Acid. 

External. — For disinfecting the holds of ships sulphur diox- 
ide, generated from burning sulphur, is largely used associated 
with steam; but in the case of apartments it has been to a 
considerable extent replaced by formaldehyde, which is more 
efficient and does not, like it, injure fabrics. When it is em- 
ployed for this purpose at least three pounds of sulphur should 
be burned for each thousand cubic feet of space (the sulphur 
candles now to be found in pharmacies furnishing the most con- 
venient method), after the room has been rendered as air-tight 
as possible. The action of the sulphurous acid is much more 
efficient when the air is saturated with moisture, and if steam 
cannot be used the walls and floors should be first sprayed with 
water. The room must be kept closed for about twenty hours. 
Scabies may be cured very rapidly by exposing the patient, his 
head excepted, to the action of sulphur dioxide, generated by 
burning 46.7 gm. (12 dr.) of sulphur in a suitable closed appa- 
ratus. Extreme care should be observed, however, to prevent 
the inhalation of the smallest amount of the poisonous gas. 
Sulphurous acid, generally considerably diluted, is sometimes 
employed as a spray or gargle in diphtheria, scarlet fever and 
septic sore-throat and as a spray in chronic bronchitis with 
profuse and fetid expectoration. Its local application is of 
service in thrush, pruritus, and parasitic skin affections, such as 
the various forms of tinea, as well as for chilblains and for foul 
ulcers and sloughing or gangrenous wounds. 

Internal. — It may be used in cases of dilated stomach, with 
fermentation and the presence of sarcinse and torulse, and of in- 
digestion with pyrosis or the vomiting of acid matters due to 
acid fermentation of the starchy or saccharine elements of the 
food; but it should be borne in mind that while it may prevent 
abnormal fermentation, it is also liable to interfere with the 
action of the normal ferments. It has been recommended in 
certain cutaneous diseases, such as urticaria and purpura, after 
other methods have failed. In the treatment of purpura it may 
be combined with the fluidextract of ergot. 



108 PHARMACOLOGY AND THERAPEUTICS. 

THYMOL. 

THYMOL.— Thymol. Dose, 0.125 gm. (125 milligm.); 2 gr. 

Preparations. 

1. Thymolis Iodidum. — Thymol Iodide. See p. 8i. 

2. Cataplasma Kaolini. — Cataplasm of Kaolin. 

3. Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 
1 fl. dr. 

Action of Thymol. 
Thymol was introduced as a substitute for phenol, which 
it resembles in its effects though it causes less stimula- 
tion of the central nervous system. It is also more slowly ab- 
sorbed, less irritant to wounded surfaces, and less poisonous to 
the higher animals and man than that drug." As regards its 
influence on fermentation and putrefaction, it has been shown to 
have a very decided antiseptic action, but although considerably 
more powerfully antiseptic than carbolic acid, it is less soluble 
in the fluids of the body, and has not, consequently, been able to 
replace it. A persistent acrid sensation in the fauces is 
caused by thymol. Although it rarely produces vomiting, large 
doses cause a feeling of warmth about the epigastrium, and 
quite frequently diarrhoea. In from half an hour to an hour, 
more or less profuse sweating is apt to occur. It also causes 
a reduction of temperature, but is regarded as less certain and 
more dangerous as an antipyretic than salicylic acid, to which 
its composition indicates a close correspondence. Convulsions 
and tremors are rarely induced in either frogs or mammals, and 
under toxic quantities the animal, after a stage of gradually 
increasing weakness and apathy, generally sinks into fatal col- 
lapse. Thymol has been found to excite a greater amount of 
irritation in the kidneys than phenol, and under its use the 
urine may contain blood, as well as albumin. The urinary 
secretion is sometimes increased, and is of a dark greenish hue, 
due to the presence of a green coloring substance. This be- 
comes blue on the addition of acid, and is thought to be nearly 



THYMOL. IO9 

related to but not identical with indigo. Experimental research 
has shown that thymol is excreted in the urine in combination 
with sulphuric and glycuronic acids, partly unchanged and 
partly oxidized to thymol-hydroquinone. 

Therapeutics of Thymol. 
The addition of a little alcohol renders possible the prepara- 
tion of a 1 to 1000 aqueous solution, which for some purposes 
may require weakening. As an antiseptic surgical dressing 
and in dermatology thymol has been used in solution and in the 
form of gauze and of ointment. One objection to its employ- 
ment is that its odor is likely to attract house flies. A product 
obtained by the condensation of thymol and chlormethyl-salicylic 
acid has recently been claimed to possess remarkable antiseptic 
properties. It is soluble in alcohol, ether and diluted alkaline 
solutions, and with alkalies salts are formed which are soluble 
in water. Thymol is quite an efficient antiparasitic, and a solu- 
tion in alcohol or ether (1 in 15) may be employed in ring-worm 
and pityriasis versicolor. An ointment containing .65 gm. to 
30 gm. (10 gr. to 1 oz.) has proved of service in psoriasis, 
eczema, acne, alopecia circumscripta, and other skin diseases. 
In the treatment of burns, especially in children, its application 
has been recommended in combination with Carron oil (Lini- 
mentum Calcis). Thymol is used to some extent in dentistry, 
and on account of its agreeable taste is quite frequently em- 
ployed as a detergent antiseptic in ulcerated and diseased con- 
ditions of the mouth and fauces. A glycerite (1 in 200) makes 
a good mouth-wash. A solution has sometimes been used by 
inhalation with advantage in bronchitis, laryngitis and whoop- 
ing-cough and as a disinfectant in diphtheria, phthisis and 
gangrene of the lung. For catarrh of the upper air-passages 
inhalations of the following mixture are highly spoken of: 
Thymol, menthol and carbolic acid, each .32 gm. (5 gr.) ; oil of 
eucalyptus, 60 c.c. (2 fl. oz.) ; oil of wild pine, 90 c.c. (3 fl. oz.) ; 
20 or 30 drops to be placed on a sponge or piece of cotton, or 
a teaspoonful may be added to boiling water and the steam in- 



I IO PHARMACOLOGY AND, THERAPEUTICS. 

haled. Thymol solutions are useful injections in gonorrhoea 
and vesical catarrh. Thymol is an internal antiseptic of some 
value. In gastric and intestinal catarrh it often acts favorably 
by arresting fermentation and stimulating digestion. In large 
doses (up to 2 gm. ; 30 gr.) it is an efficient anthelmintic for 
the Ankylostoma duodenale. On account of the danger of 
toxic effects, the patient should be warned not to take any sol- 
vent of thymol, such as alcohol, oils, etc., after the administra- 
tion of the remedy. Thymol carbonate, under the name of 
thymotal, has been recently recommended as especially valuable 
in ankylostomiasis. Thymol, both alone and in combination 
with gallic acid, is reported to have been used successfully in 
some cases of chyluria of filarious origin. It is of no practical 
value as an antipyretic, as the doses required to affect the 
temperature in fevers are so large as to be extremely apt to 
cause dangerous depression of the vital powers. As an internal 
remedy thymol has been recommended in acute rheumatism, 
tuberculosis, diabetes, typhoid fever, and other constitutional 
diseases, but has proved entirely inefficient. 

BALSAM OF PERU. 

BALSAMUM PERUVIANUM.— Balsam of Peru. Dose, 1 gm.; 
15 gr. 

Action of Balsam of Peru. 
It is a general stimulant, with a special tendency to the 
mucous membranes. On the skin it produces slight reddening, 
and its external application is occasionally followed by an ery- 
thematous, urticarial, or eczematous eruption. It has some 
antiseptic property, and is efficient in the destruction of animal 
and vegetable parasites. It also allays itching of the skin and 
mucous membranes. By its stimulating action on wounds and 
sores it facilitates the repair of tissue. Internally it is stomachic, 
carminative and expectorant. In large doses it may act as a 
gastro-intestinal irritant, inducing vomiting and purging, but 
in smaller quantities causes some heat of skin and stimulates the 
circulation. It is excreted by the skin, kidneys and respiratory 



BALSAM OF PERU. I I I 

mucous membrane, and during its elimination is believed to 
stimulate and have a tendency to disinfect the secretions from 
these parts. The fact that in some cases, after large doses, 
the addition of acid to the urine is followed by the formation of 
an abundant precipitate has led to the opinion that the drug 
has an irritant action on the kidneys ; but in most instances the 
precipitate is found to be dissolved by alcohol, which would go 
to show that it consists of resin, and not albumin. In one case, 
however, it is stated that an inunction of 18.5 c.c. (5 fl. dr.) 
of the balsam gave rise to nephritis and dropsy. 

Therapeutics of Balsam of Peru. 
External. — Balsam of Peru has long been used, either pure or 
diluted, as an application to wounds, compound fractures, and 
indolent sores. As a stimulating dressing for sluggish granu- 
lations a 5 to 10 per cent, solution in castor oil is frequently 
employed. This substance, saturating a number of layers of 
gauze, over which oiled silk or a starch bandage is applied, is 
very efficient in maintaining drainage in wounds, abscesses, 
burns, etc. It is also an excellent deodorant, and is said to 
cover to a large extent the disagreeable odor of iodoform when 
it is used in connection with it. Balsam of Peru is a good 
local application for diphtheria, for chilblains, and for sore 
nipples and cracked lips, and is useful in moderating the dis- 
charge of pus in chronic catarrhal conditions of the nose, the 
ears or the vagina. When used for fissured nipples it should 
be removed before the child is allowed to nurse. One case of 
fatal gastritis in an infant six days old is recorded which is 
stated to have been caused by balsam of Peru applied to the 
mother's nipples. It is one of the best known remedies for 
pruritus vulva and other varieties of pruritus, especially the 
senile, and is generally applied pure in these conditions. It is 
successful in removing leucoplakia, or local epithelial thickening 
of the mucous membrane, and is of considerable* service in 
chronic inflammatory diseases of the skin, especially eczema. 
One of its principal uses is as a parasiticide in ringworm, pedi- 



I I 2 PHARMACOLOGY AND THERAPEUTICS. 

culosis, and scabies, and for this purpose an ointment consist- 
ing of balsam of Peru, 20; olive oil, 50; petrolatum, 100, may- 
be employed. For scabies it should be employed in the same 
manner as sulphur ointment (see p. 100). It is as efficient as 
the latter, killing the eggs as well as the acarus, and is at the 
same time much more agreeable to the patient. Sometimes the 
balsam is used in combination with sulphur. 

Internal. — It is often a very useful remedy in chronic bron- 
chitis and bronchorrhcea, as well as at times in chronic intestinal 
catarrh and dysentery. It has also been employed in the gastro- 
intestinal disorders of childhood. It may be given alone in 
capsules or emulsion, or in mixtures with other drugs. Some 
time ago it was claimed that by the use in phthisis of subcu- 
taneous and intravenous injections of balsam of Peru and its 
chief constituent cinnamic acid, as well as of its sodium salt, 
hetol, a specific inflammation of the diseased areas might be set 
up, which would subsequently result in cicatrization of the tuber- 
culous nodules. Most of those who have employed this treat- 
ment, however, pronounce against it, and it has not been re- 
ceived with general favor, as no conclusive evidence has been 
presented that the alleged effects are produced. At the same 
time, when given by the mouth or by inhalation, its expectorant 
action may no doubt sometimes be of more or less service in 
this disease. Other uses of the balsam are in the treatment of 
gleet, leucorrhcea and chronic laryngitis (by inhalation). 

B. Anthelmintics. 
MALE FERN. 
ASPIDIUM.— Male Fern. Dose, 4 gm.; 60 gr. 

Preparation. 
Oleoresina Aspidii. — Oleoresin of Aspidium. Dose, 2 gm.; 
30 gr. 

Action of Male Fern. 
When given in ordinary doses this drug generally passes 
through the system, even when some absorption takes place, 



MALE FERN. I I 3 

without giving rise to any symptoms, though there may be 
slight intestinal disturbance. When large quantities are taken, 
or if for any reason an unusual amount of its active constitu- 
ents become absorbed, alarming and even fatal results may be 
observed. Recently several cases of poisoning have been re- 
ported, presumably not due to an excessive dose, but to the fact 
that castor oil was administered at the same time, with the 
effect of notably increasing the absorption of filicic acid. The 
toxic symptoms consist of nausea, vomiting, purging, intense 
abdominal pain, muscular weakness, cramps in the extremities, 
tremors, increased reflexes, confusion of ideas, and somnolence 
deepening into coma, with collapse. The secretion of urine is 
apt to be diminished. In many cases disturbances of vision, or 
even complete loss of sight, occur, without any distinct ophthal- 
moscopic appearances, and sometimes there are convulsions, 
which may be tetanic in character and accompanied with opis- 
thotonos. In a considerable proportion of instances icterus is 
present, and is thought to probably result from the duodenal 
catarrh, though it may possibly be due to destruction of the 
red corpuscles of the blood. After death the gastro-intestinal 
mucous membrane is found to be congested, swollen, and some- 
times dotted with ecchymoses, and degeneration of the nerve- 
fibres is also observed. The treatment recommended for poison- 
ing by aspidium is the administration of magnesium sulphate 
by the mouth and ammonia by subcutaneous injection. 

Therapeutics of Male Fern. 
Aspidium acts as a direct poison to tape-worms, and is one 
of the most certain of all remedies for these entozoa. It is also 
used against the Ankylostoma duodenale, and the ethereal ex- 
tract of male fern has proved of service in the treatment of 
cysticercus disease. In cases of the latter the result is stated 
to have been especially favorable when the lesions were situated 
in the subcutaneous or muscular tissues. The drug is considered 
more successful against the Taenia solium (the armed variety of 
tape-worm) and the Bothriocephalic latus (for which it is 
9 



114 PHARMACOLOGY AND THERAPEUTICS. 

especially efficient) than against the Tcunia medio-canellata. For 
a day before taking the medicine the patient should use a liquid 
diet, such as milk or beef-tea. On the following morning, the 
bowels having been previously evacuated, he should take, fast- 
ing, a full dose of the oleoresin, which may be administered in 
pills or capsules or in a draught made up with mucilage and 
flavored with ginger, cinnamon or peppermint. A good way 
also to give it is with an equal quantity of aromatic syrup of 
rhubarb. It is sometimes advised that the dose should be re- 
peated in two or three hours. In the middle of the day the 
patient may eat a full meal, and in the evening should take a 
brisk cathartic. Castor oil or other oils should not be used, on 
account of the danger of increasing the absorption of filicic 
acid, and thus causing toxic symptoms. The head of the tape- 
worm should be carefully searched for in the stools. 

KAMALA. 

KAMALA (U. S. P., 1890; no longer official).— Kamala. (Rott- 
lera.) Dose, 4 to 8 gm.; 1 to 2 dr. 

Action of Kamala. 

Kamala is an anthelmintic, and also a somewhat drastic 
purgative. As a rule, it does not cause nausea or vomiting, but 
sometimes this is the case. As it imparts its virtues to alcohol, 
a tincture made from it is quite as efficient a vermicide as the 
powder. 

Therapeutics of Kamala. 

It will kill the Tcunia solium, and probably also the Oxyuris 
vermicularis and the Ascaris lumbricoides. For tape-worm it 
is customary to give one full dose of the powder, mixed with 
syrup, to which a little hyoscyamus is added to prevent griping, 
and the parasite is often expelled dead at the third or fourth 
stool after the use of the drug. If one dose proves insufficient, 
it may be repeated every three hours until five or six doses 
have been taken. In the East kamala is employed, in the 
form of ointment, in the treatment of various skin diseases, 



POMEGRANATE. 115 

particularly scabies. In Europe it has been successfully used 
in herpetic ring-worm. 

KOUSSO. 

CUSSO.— Kousso. (Brayera. Kooso.) Dose, 16 gm.; 240 gr. 

Unofficial Preparation. 
Koussinum.— Koussin. Dose, 1.20 to 2.40 gm.; 20 to 40 gr. 

Action of Kousso. 
Kousso is an anthelmintic and gastro-intestinal irritant. 
Koussin is thought to be less liable to produce nausea than the 
drug itself. According to recent authorities the active principle - 
of cusso is kosotoxin, a non-nitrogenous neutral principle, 
which is stated to be an energetic paralyzant to all muscles, in- 
cluding the heart, and also of the motor nerve-endings. It has 
been alleged that cusso is capable of bringing on abortion, but 
such action upon the uterus has never been conclusively shown. 

Therapeutics of Kousso. 

It is used exclusively in the treatment of tape-worm, and its 
efficiency appears to depend considerably on the freshness of 
the flowers employed. Objections to its use are that it is 
often retained with difficulty and is apt to create intestinal 
distress. It may be administered in an infusion or in the form 
of the fluid extract, and should be taken in the morning on an 
empty stomach. 

Koussin has been given with good results. It is most con- 
veniently administered in capsules. 

POMEGRANATE. 

GRANATUM. — Pomegranate. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Granati. — Fluidextract of Granatum. Dose, 
2 c.c; 30 tc\.. 



i 1 6 pharmacology and therapeutics. 

Action of Pomegranate. 

On account of the large amount of tannin which it contains, 
pomegranate is apt to disturb the stomach and cause nausea 
and vomiting. It also occasions flatulence and intestinal pain, 
and sometimes, but not always, acts freely on the bowels. Other 
symptoms produced by large doses of the drug are general weak- 
ness, muscular tremors and cramps, particularly in the leg- 
muscles, hebetude, vertigo, and mental confusion, without loss 
of consciousness. The urine is increased in quantity. Like 
male fern, pomegranate frequently causes disturbances of 
vision and diplopia, mydriasis and amaurosis have been ob- 
served. 

Therapeutics of Pomegranate. 

Pomegranate is exceedingly unpalatable and is so liable to 
cause emesis that the purpose of the drug may be thus defeated. 
When retained by the stomach it is usually an efficient remedy 
for tape-worm. It is best administered in decoction (B. P., i to 
5; dose, 15 to 60 c.c; y 2 to 2 fl. oz.), and of this several doses 
may be taken, fasting, at intervals of an hour. It should be 
preceded by a brisk cathartic, and, if the remedy does not have 
a purgative effect, followed by another. In case the patient 
is unable to take the decoction in this way it is recommended 
that the requisite quantity should be evaporated in a water-bath 
to a pilular consistency and administered in capsules, preceded 
and followed by a cathartic. On account of its powerful as- 
tringent properties pomegranate is sometimes employed for the 
same purposes as tannic acid and other astringent remedies. 
Thus, the decoction has been used as an injection in gonorrhoea, 
leucorrhcea, etc., and, flavored wth orange or aromatics, as a 
gargle for sore-throat and relaxed states of the fauces. Inter- 
nally pomegranate has been advantageously employed in the 
diarrhoea and dysentery of hot climates, and also in Meniere's 
disease. 

PELLETIEEIKffi TANNAi=>.— Pelletierine Tannate. Dose, 0.250 
gm. (250 milligm.) ; 4 gr, 



PUMPKIN SEED. \\J 

Action of Pelletierine Tannate. 
Pelletierine, the mixture of active principles of pomegranate, 
in sufficient quantity, acts like curare, causing paralysis of the 
motor nerves, without affecting sensation or muscular contractil- 
ity. In the frog it also acts upon the heart muscle, the pulsa- 
tions being slowed, although they may temporarily increase in 
force. It has been proved experimentally to have a specific 
toxic action on tape-worms, a solution of one part in 10,000 
causing their death in ten minutes, while other intestinal worms 
were unaffected by stronger solutions. For practical purposes 
pelletierine tannate is the most effective and least dangerous 
form of the drug, as its insolubility no doubt prevents its rapid 
absorption and ensures its prolonged contact with the worm. 

Therapeutics of Pelletierine Tannate. 
It is one of the most reliable of tseniafuges, and is decidedly 
preferable to pomegranate itself on account of the facility 
with which it can be taken and its freedom from nauseating 
properties. It is usually given in capsules, and, like pomegran- 
ate, should be preceded and followed by a purgative. It should 
be administered with great caution to children. Pelletierine 
has been found successful in affording relief in paralysis of 
the third and sixth nerves. 

PUMPKIN SEED. 

PEPO.— Pepo. (Pumpkin Seed.) Dose, 30 gin.; 1 oz. 

Action of Pumpkin Seed. 
Pepo is one of the most efficient and at the same time harm- 
less taeniafuges. It has no purgative action or other known 
physiological effects. 

Therapeutics of Pumpkin Seed. 
It is employed exclusively as an anthelmintic for the tape- 
worm, and is preferably given in the form of emulsion. 60 gm. 
(2 oz.) of the fresh seed are powdered in a mortar, with 240 c.c. 



Il8 PHARMACOLOGY AND THERAPEUTICS. 

(8 fl. oz.) of water, until the husks are loosened and an emul- 
sion is made. The mixture is then strained, and the whole 
amount taken fasting. By some it is maintained, however, that 
the effect is better if the husks are retained in the emulsion. 
Sometimes the seeds are beaten into a paste with milk and white 
sugar. The resin, in doses of I gm. (15 gr.), and the expressed 
oil, which is bland and unirritating, in doses of 15 c.c. (4 fl. dr.), 
have been used as substitutes for the seeds, and are said to be 
equally efficient. Some practitioners are in the habit of asso- 
ciating the oleoresin of male fern with pumpkin seed in the 
treatment of tape-worm, and others of adding pomegranate to 
this combination. 

SANTONIN. 

1. SANTONICA.— Santonica. (Levant Wormseed.) 

2. SANTONINUM.— Santonin. Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 

Preparation. 
Trochisci Santonini. — Troches of Santonin. 

Action of Santonin. 
Santonin is a very efficient vermifuge for the Ascaris lum- 
bricoides. Its modus operandi is not definitely understood. It 
has generally been supposed that it has a specific destructive 
action upon ascarides; but experiment outside the body has 
demonstrated that it is not directly fatal to these parasites, and 
the most satisfactory explanation of the anthelmintic action of 
the drug is that it renders the small intestine so disagreeable 
a habitat for them that they are driven down into the lower 
bowel, from which they are dislodged by the purgative medicine 
employed in connection with the santonin. On the human 
system santonin has distinct effects, resulting from its absorp- 
tion, the most characteristic of which is a derangement of color 
vision. There is also a discoloration of the urine (lemon-yel- 
low or saffron when the latter is acid, and carmine or purplish 
red when it is alkaline), similar to that resulting from chryso- 
phanic acid, as in rhubarb and senna. The faeces, likewise, 



SANTONIN. II9 

sometimes assume a deep yellow color. Ordinarily a portion of 
the santonin is dissolved by the alkalies in the stomach, with 
which it forms soluble and absorbable santoninates, while the 
remainder passes into the intestine; but under special circum- 
stances the greater part of the drug may be absorbed in the 
stomach and cause general intoxication of the system. Santonin 
always undergoes some oxidation in the tissues, and is said to 
be excreted in the urine and faeces in several forms, two of 
which have been found to be oxysantonins. Even small doses 
give rise to xanthopsia, or yellow vision. In this disorder 
white light has at first a violet hue, usually lasting but a short 
time, and then a greenish-yellow color, which tints the entire 
field of vision; and the same has occasionally been observed 
with amyl nitrite. The power of seeing in dim light is also 
stated to be lessened. These effects have been demonstrated to 
be peripheral, and consequently are not due to discoloration of 
the media of the eye. The symptoms produced by large doses of 
santonin are much the same in man as in other animals. Those 
observed in experiments on dogs have been found to be as fol- 
lows : Twitching of the muscles of the head, often beginning on 
one side; followed by rolling of the eyes, grinding of the teeth, 
flexion and extension of the neck and rotation of the head from 
side to side, later by regular epileptiform convulsions, in which 
the animal is first thrown into opisthotonos and then into clonic 
spasms of the limbs and trunk. These are interrupted by inter- 
vals of repose, during which a momentary contraction of all the 
muscles of the body may take place. During the convulsive 
seizures the respiration is irregular and insufficient, and in 
fatal cases it fails to return after the convulsion passes off, and 
the animal dies of asphyxia. In man aphasia has occasionally 
been noted, and some mental confusion, as well as nausea and 
vomiting, may result from doses too small to cause convulsions. 
The epileptiform convulsions are believed to be due principally 
to stimulation of the cortex and the brief contractions in the 
intervals of repose to increased activity of the parts between the 
cerebral peduncles and the medulla. That the medullary centres 



120 PHARMACOLOGY AND THERAPEUTICS. 

are comparatively little affected seems to be shown by the fact 
that the respiration, interfered with during the spasms, returns 
to its ordinary rate and strength during the intervals. The 
circulation is found to be deranged only by the asphyxia, while 
the heart continues to beat long after the respiration has ceased. 
Santonin lowers the temperature, and this is attributed to its 
action on the central nervous system. 

Therapeutics of Santonin. 
Santonin is now almost universally used as a remedy for 
round-worms. Upon tape-worms and the Oxyuris vermicularis 
it has very little effect. In addition to its efficiency, it is espe- 
cially serviceable on account of the ease with which it can be 
administered to children. Owing to its insolubility in water 
its taste is only very slightly bitter, and it may be readily given 
in powdered sugar or sprinkled upon bread and honey. It is 
generally most effective when exhibited two or three times a 
day until five or six doses have been taken, when a cathartic 
is to be administered. Lozenges containing it are not to be 
commended, as they may fail to dissolve. Santonin has at 
times been tried in amaurosis, epilepsy, suppressio mensium, 
and other conditions, but is now probably exclusively employed 
as an anthelmintic. Sodium santoninate, on account of the 
untoward effects to which it has- given rise, should not be 
administered. 

TOXICOLOGY. 

Symptoms. — A number of deaths from santonin are on record, and 
in a few exceptional instances serious or even fatal effects have been 
caused by quite small doses. The danger of poisoning is lessened if 
the drug is given in castor oil. In cases of poisoning by santonin, in 
addition to the nervous phenomena described, there are generally 
marked pallor and coldness of the surface, with a blue tint around the 
eyes or involving the whole face, dilatation of the pupils, and sweat- 
ing, which is sometimes very profuse. As has been mentioned, the 
temperature is reduced, and there may be gastric or intestinal pain. 

Treatment. — Evacuation of the stomach and bowels. Ammonia, or 
strychnine sulphate hypodermatically. The convulsions may be con- 
trolled by ether or chloroform. 



SPIGELIA. 121 



SPIGELIA. 



SPIGELIA.— Spigelia. (Pinkroot. Carolina Pink.) Dose, 4 gm.; 
CO gr« 

Preparation. 
Fluidextractum Spigelian — Fluidextract of Spigelia. Dose, 
4 c.c; 1 fl. dr. 

Unofficial Preparation. 
Fluidextractum Spigelian et Senna?. — Fluidextract of Spigelia 
and Senna. Dose, 8 to 15 C.C.; 2 to 4 fl. dr. for an adult; 2 
to 4 C.C.; y 2 to 1 fl. dr., for a child two years old. 

Action of Spigelia. 
Spigelia is an efficient anthelmintic against the round-worm, 
and appears to act very much in the same way as santonin. 
Given in sufficient amount, it has toxic effects upon the human 
subject and upon animals. In the dog or cat its subcutaneous 
injection gives rise to retching and vomiting, muscular weak- 
ness and incoordination, hurried and dyspnceic respiration, 
mydriasis, exophthalmia, and restlessness, followed by somno- 
lence, coma and death from failure of the respiratory centre. 
Small quantities, given by the mouth, produce no symptoms, but 
large doses, especially in the case of children, may cause flush- 
ing and dryness of the skin, frequently associated with cedem- 
atous swelling of the face, and such cerebral symptoms as 
vertigo, dimness of vision, spasm of the facial muscles, stupor 
and even convulsions. Experiment has shown that toxic doses 
slow and weaken the heart's action and depress the motor spinal 
cord and the respiratory centre. 

Therapeutics of Spigelia. 
Spigelia has long been a popular and reliable remedy for 
lumbricoid worms. It is much less liable to give rise to symp- 
toms of narcotic poisoning when it is given in combination with 
a cathartic, and senna is usually employed for this purpose. 
Santonin is sometimes prescribed in connection with the fluid- 
extracts of spigelia and senna. The fluidextract of spigelia and 



122 PHARMACOLOGY AND THERAPEUTICS. 

senna, which contained a small proportion each of the oils of 
anise and caraway, was formerly official. It is a very good 
preparation, and pleasant to take. The dose of spigelia, com- 
bined with a cathartic, should be repeated every four hours 
until a purgative effect is produced. 

CHENOPOPODIUM. 

Unofficial Preparation. 
CHENOPODIUM (U. S. P., 1890).— Chenopodium. (Ameri- 
can Wormseed.) Dose, 1 to 2 gm.; 15 to 30 gr. 

OLEUM CHENOPODIL— Oil of Chenopodium. Dose, 0.2 c.c; 
3 TTl. 

Action of Chenopodium. 
Wormseed is one of the most efficient anthelmintics, particu- 
larly against Ascarides. The oil acts as a stimulant to the 
circulation and nervous system. It is said to increase the 
cardiac rate and to promote the secretions of the skin, bronchi 
and kidneys. Chenopodium album, known as white goose-foot 
and hog-weed, is possessed of some haemostatic properties. 

Therapeutics of Chenopodium. 
The oil has sometimes been given in infantile colic, flatulent 
dyspepsia, chorea, hysteria, neurasthenia, chronic malaria, and 
amenorrhcea, but at the present time is used almost exclusively 
as an anthelmintic. For this purpose it may be given dropped 
on lump sugar, in capsules, or in emulsion. The dose is usually 
repeated three times a day, before meals, for two days, when a 
cathartic should be ordered. It is, no doubt, the safest vermi- 
fuge in case the mucous membrane is inflamed, as it not only 
causes the expulsion of the worms, but also appears to have 
a beneficial action upon the intestinal irritation. 

C. Antiparasitics. 

CHRYSAROBIN. 

CHRYSAROBINUM.— Chrysarobin. Dose, 0.030 gm. (30 mil- 
ligm.) ; y 2 gr. 



CHRYSAROBIN. 1 23 

Preparation. 
Unguentum Chrysarobini. — Chrysarobin Ointment. 

Action of Chrysarobin. 

External. — Chrysarobin has a deep and strong local irritant 
action. Applied to the skin it induces itching, redness and 
swelling, and in some instances follicular or furuncular derma- 
titis. It stains the skin and clothing a dark yellowish-brown or 
purple color, which may, however, be removed by a weak solu- 
tion of chlorinated lime or caustic soda, provided no soap or 
alkali has been used. Its application to the skin has been 
known to cause slight albuminuria. A certain amount is ab- 
sorbed from the skin, and if it is applied over an extended area 
it may give rise to constitutional symptoms. It is also irritant 
to mucous membranes. Small quantities will excite conjuncti- 
vitis, and the inflammation set up by it is sometimes so severe 
as to result in corneal ulceration. It is said that those engaged 
in collecting the drug (goa powder) often suffer from irritation 
of the face and eyes, with palpebral oedema. In a dilute form 
chrysarobin acts as a reducing agent, having the property of 
taking oxygen from the tissues and promoting the growth of 
normal epithelium. The drug is a vegetable parasiticide, being- 
poisonous to organisms of a fungous type. 

Internal. — Chrysarobin is a decided gastro-intestinal irritant. 
It produces copious, watery, brownish-colored stools, with re- 
peated vomiting, but not much nausea. The greater part of it 
passes through the tissues unchanged; the remainder is ab- 
sorbed and undergoes oxidation to chrysophanic acid. The 
portion absorbed is excreted in the urine, to which it imparts a 
yellow color, which turns to red upon the addition of alkalies. 
In animals it has been observed to cause severe nephritis (in 
which the glomeruli were less affected than the epithelium of 
the tubules), with albumin and sometimes blood in the urine. 

Therapeutics of Chrysarobin. 
It is largely used locally for its stimulating action in certain 
chronic inflammatory diseases of the skin, and also for its cura- 



124 PHARMACOLOGY AND THERAPEUTICS. 

tive effect upon vegetable parasitic eruptions, such as the vari- 
ous forms of tinea. In the former class it is of service in the 
treatment of eczema, acne rosacea, lupus vulgaris, and especially 
psoriasis, in which it is considered by many the best known ex- 
ternal remedy. It should always be used with caution, as it is 
liable to set up dermatitis of the surrounding integument. It is 
recommended that the official ointment should be considerably 
diluted before application, on account of the danger of exciting 
too much inflammatory reaction. In many instances the best 
way to use it is in the form of a pigment composed of chrysa- 
robin, I ; solution of gutta percha (made by decantation of gutta 
percha, i; lead carbonate, i; chloroform, 9), 9. This can be 
painted with accuracy on the parts desired, and is less liable to 
stain. Another cleanly manner of employing chrysarobin is by 
dissolving 1 part in 7 parts of chloroform, and stirring an equal 
quantity of soft petroleum into the mass ; applying by means of 
a brush. It may also be conveniently applied in the form of a 
stick made up with rosin, yellow wax and olive oil. Chrysa- 
robin should rarely or never be used on the face, on account 
of the danger of inducing oedema of the eyelids or conjunctivi- 
tis. For the same reason it should also be used with great cau- 
tion on the scalp. Alopecia circumscripta and ringworm of the 
scalp, however, have both been very successfully treated by 
means of it. It is affirmed by some that the action of this drug 
upon certain cutaneous affections is not only local but also con- 
stitutional, the opinion being expressed that, absorbed from one 
part of the skin (as, for instance, one limb), it is capable of 
exerting a beneficial influence upon other parts of the skin (as 
another limb) to which it has not been directly applied. How- 
ever this may be, there seems to be little question that in many 
of the conditions in which chrysarobin has been employed 
equally good results may be obtained by other remedies which 
are not so irritating and so liable to give rise to unpleasant 
effects. Excellent results have been claimed in external 
haemorrhoids from the use of a salve containing chrysarobin, 
iodoform and extract of belladonna, and in internal haemor- 



STAPHISAGRIA. I 25 

rhoids from suppositories made up with the same ingredients. 
The extremely irritating effect of chrysarobin upon the intes- 
tinal tract, when given internally, renders it practically useless 
as a cathartic or systemic remedy. It has been tried in small, 
repeated doses, especially in psoriasis, but the vomiting, grip- 
ing, purging, and depression resulting have necessitated its 
abandonment. 

STAPHISAGRIA. 

STAPHISAGRIA.— Staphisagria. (Stavesacre.) Dose, 0.065 gm. 
(C5 milligm.); 1 gr. 

Preparation. 
Fluidextractum Staphisagrise. — Fluidextract of Staphisagria. 
Dose, 0.05 c.c; 1 TTL- 

Unofficial Preparation. 
Delphinina.— Delphinine. Dose, 0.001 to 0.008 gm.; -^ to 

Action of Staphisagria. 
It is a parasiticide and is irritating to the skin, producing ery- 
thematous inflammation. Taken internally it is a gastrointesti- 
nal irritant and a depressant to the motor nerves, heart and 
respiration, causing death by asphyxia. 

Therapeutics of Staphisagria. 
It is principally used in pediculosis, and may be applied in 
the form of ointment (B. P. Staphisagria, 4; yellow wax, 2; 
benzoated lard, 17). Sometimes the dry powder is dusted over 
the affected surface, and sometimes the fluidextract is used in 
combination with diluted acetic acid. An oil has also 
been extracted from the seeds by ether, and it is applied 
in an ointment (4 c.c; 1 fl. dr. to 30 gm. ; 1 oz. of lard) or 
diluted with from 6 to 12 parts of almond or olive oil. These 
applications are also efficient in scabies and in prurigo senilis. 
In using staphisagria externally care should be taken not to 
apply it to an abraded scalp, and only upon the unbroken skin. 
A case is recorded in which its too free use upon a child was 



I 



126 PHARMACOLOGY AND THERAPEUTICS. 

attended with fatal results. Delphinine has been employed both 
externally and internally, principally for neuralgic affections, 
but is not as efficient as various other remedies. It is very 
much less poisonous than aconitine. 

Unofficial Preparations. 
PICROTOXINUM (U. S. P., 1890).— Picrotoxin. Dose, 
0.0005 to 0.001 gm.; T ^ to ^ gr. 

Decoctum Cocculi. — Decoction of Cocculus. Dose, 4 to 8 
c.c; 1 to 2 fl. dr. 

Tinctura Cocculi. — Tincture of Cocculus. Dose, 0.12 to 1 
c.c; 2 to 15 TT1 . 

Action of Picrotoxin. 

External. — Picrotoxin, being very destructive to lower forms 
of life, is an energetic parasiticide. 

Internal. — It is a powerful poison, causing vomiting, accelera- 
tion of respiration, slowing of the pulse and palpitation of the 
heart, stupor and unconsciousness, tonic spasms passing into 
clonic, collapse, repetition of convulsions, and asphyxia. The 
clonic spasms are entirely different from those produced by 
strychnine, and the central nervous effects of the drug are due 
mainly to its action on the medulla oblongata; the spinal cord 
and the higher parts of the brain remaining comparatively little 
affected. As the result of the intense stimulation of the 
medulla, there is clonic contraction of the muscles throughout 
the body. In the frog, spasm of the laryngeal muscles, by pre- 
venting the escape of air from the lungs, leads to a characteristic 
bloating of the animal. It has been found that picrotoxin, like 
other convulsive poisons, tends to lower the temperature when 
given in quantities insufficient to cause the spasms. In very 
small doses it appears to act as a bitter tonic to the gastro- 
intestinal tract, increasing secretion and promoting peristalsis. 

Therapeutics of Picrotoxin. 
External. — In an ointment of the cocculus seeds in lard (1 to 
6) cocculus is efficient in destroying pediculi and the acarus sca~ 



PICROTOXIN. 127 

bei and for the relief of trichophytosis, tinea versicolor, and 
other parasitic affections, but its use is attended with consider- 
able danger from poisoning. Care is therefore necessary, and 
abraded surfaces should be avoided. There is less risk if a 
solution (15 c.c. ; 4 fl. dr. of the tincture to 120 c.c. ; 4 fl. oz. 
of water) or decoction (1 to 16) is applied to the scalp for a 
few minutes for phthiriasis, or lousiness, and then washed 
off with warm water. Two or three daily applications may be 
sufficient. As the best way of employing this remedy, however, 
in the treatment of animal and vegetable parasitic affections, it 
is recommended that a small quantity of picrotoxin (not exceed- 
ing 1 per cent.) be prescribed in combination with mercuric 
oleate ointment (B. P. — Mercuric oleate, 20; benzoated lard, 
60). 

Internal. — Picrotoxin has been advised in atonic conditions 
of the stomach and cases of torpor of the intestines dependent 
upon deficient secretion and paresis of the muscular layer. In 
migraine associated with the menstrual period and in nervous 
dysmenorrhea it is said sometimes to afford relief if given a 
day or two before the flow. Some observers have found it of 
benefit in epilepsy, especially of the nocturnal and anaemic types 
and in cases attributable to onanism, while others assert that it 
really tends to aggravate the paroxysms. It has been tried in 
other nervous diseases, such as chorea, infantile convulsions, 
and various forms of paralysis, but the results thus far have 
not been such as to inspire confidence in its efficacy. There is 
one application of the drug, however, in which all appear to 
agree as to its utility, at least in many instances, namely in the 
treatment of the night-sweats of phthisis. It does not produce 
the disagreeable dryness of the skin and throat caused by atro- 
pine, and not infrequently succeeds in cases where the latter 
fails. It acts less promptly than that remedy, however, and it 
is generally necessary to repeat the dose for four nights in suc- 
cession before the sweating is completely controlled. The effect 
thus produced then lasts for from ten to fourteen days. This 
action of picrotoxin has been explained by its influence in in- 



128 PHARMACOLOGY AND THERAPEUTICS. 

creasing the respiration, which, through the partial asphyxia 
caused, prevents the stimulation of the mechanism of perspira- 
tion. In order to secure the desired result more quickly it may 
be given three times a day. It is also useful in other forms of 
hyperidrosis. It is administered in tablets or pills or in solu- 
tion, and to keep better it is recommended that glacial acetic 
acid should be added to the latter. It is also sometimes injected 
hypodermatically, and tablets containing .0006 gm. (y^-g- gr.) 
each are prepared for this purpose. As it has been demon- 
strated by experimental research that picrotoxin is the physio- 
logical antagonist of chloral in rabbits and other animals, it 
would seem likely to prove of service in the treatment of poison- 
ing by that drug. Conversely, in cases of poisoning by picro- 
toxin chloral should be used, together with anaesthetics, to con- 
trol the spasms. The combined administration of chloral, mor- 
phine and minimal doses of atropine has recently been recom- 
mended as the result of animal experiments. 

D. Antiperiodics. 
CINCHONA. 

1. CINCHONA.— Cinchona. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Cinchonae. — Fluidextract of Cinchona. 
Dose, 1 c.c; 15 m,. 

2. Tinctura Cinchonae. — Tincture of Cinchona. Dose, 4 c.c; 
1 fl. dr. 

2. CINCHONA RUBRA.— Red Cinchona. Dose, 1 gm.; 15 gr. 

Preparation. 
Tinctura Cinchonae Composita. — Compound Tincture of Cin- 
chona. Dose, 4 c.c; 1 fl. dr. 

3. QTJININA— Quinine. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparations. 
1. Elixir Ferri, Quininae et Strychninae Phosphatum.— 
Elixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 



CINCHONA. 129 

2. Glyceritum Ferri, Quininse et Strychninae Phosphatum. — 
Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 C.C.; 15 TTL- 

3. Syrupus Ferri, Quininae et Strychninae Phosphatum. — 
Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 

4. Syrupus Hypophosphitum Compositus. — Compound Syrup 
of Hypophosphites. Dose, 8 c.c.; 2 fl. dr. 

4. QUININE SULPHAS.— Quinine Sulphate. Dose, 0.250 gm. 
(250 milligm.); 4 gr. 

5. QUININE BISULPHAS.— Quinine Bisulphate. Dose, 0.250 
gm. (250 milligm.); 4 gr. 

6. QUININE HYDROBROMIDUM. — Quinine Hydrobromide. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

7. QUININE HYDROCHLORIDUM. — Quinine Hydrochloride. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

8. QUININE SALICYLAS.— Quinine Salicylate. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

9. OLEATUM QUININE.— Oleate of Quinine. 

10. CINCHONINiE SULPHAS. — Cinchonine Sulphate. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

11. CINCHONIDINiE SULPHAS.— Cinchonidine Sulphate. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 

1. Extractum Cinchonas (U. S. P., 1890). — Extract of Cin- 
chona. Dose, 0.30 to 2 gm.; 4 to 30 gr. 

2. Infusum Cinchonae (U. S. P., 1890). — Infusion of Cinchona. 
Dose, 30 to 60 c.c; 1 to 2 fl. oz. 

3. Cinchonina. — Cinchonine. Dose, 0.050 to 2 gm.; 1 to 30 
gr. 

4. Cinchonidinae Salicylas. — Cinchonidine Salicylate. Dose, 
0.060 to 1.20 gm.; 1 to 20 gr. 

5. Quininae Carbamas.— Quinine Carbamide. (Quinine Urea.) 
Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

10 



130 PHARMACOLOGY AND THERAPEUTICS. 

6. Quininae Kinas.— Quinine Kinate. Dose, 0.30 to 1.20 gm.; 
5 to 20 gr. 

7. Quininae Sulphovinas.— Quinine Sulphovinate. Dose, 0.30 
to 1.20 gm.; 5 to 20 gr. 

8. Quininae Tannas. — Quinine Tannate. Dose, 0.050 to 1.20 
gm.; 1 to 20 gr. 

9. Quininae Valerianas (U. S. P., 1890).— Quinine Valerianate. 
Dose, 0.050 to 2 gm.; 1 to 30 gr. 

10. Quinidinae Sulphas (U. S. P., 1890).— Quinidine Sulphate. 
Dose, 0.050 to 1.20 gm.; 1 to 20 gr. 

Action of Cinchona and its Alkaloids. 

Cinchona owes its effects on the organism almost entirely to 
the quinine in it. The bark, however, is more of a gastric 
irritant than quinine and is also a decided astringent, while on 
account of its bulk its active principles are more slowly ab- 
sorbed. Large doses of it have been known to cause an ap- 
parently well-marked febrile paroxysm, beginning with chill 
and terminating with slight perspiration, but quinine, while its 
untimely use may reproduce the paroxysm with more or less 
severity in a malarial subject, has been found incapable of ex- 
citing such symptoms in a healthy individual. Quinine sul- 
phate, bisulphate, hydrochloride and hydrobromide have the 
same action as quinine itself. The action of the drug may be 
most conveniently studied from the effects of quinine sulphate, 
which from its general use is commonly known simply as 
quinine. 

External. — Quinine has little or no influence upon sound 
skin, but is distinctly irritant to mucous membranes and raw 
surfaces. It is recognized as a protoplasm poison, its action 
extending with but little variation throughout most forms of 
living matter, and generally consisting in a transient augmen- 
tation of activity which is followed by depression and death. 
Quinine solutions, therefore, have considerable antiseptic 
power, while the lactic, butyric and alcoholic fermentations, 
through the effects of the alkaloid on the organisms, are either 



CINCHONA. 131 

retarded or completely prevented. It appears to have an 
elective action, however, since it has been found devoid of in- 
fluence upon some of the lower forms, as, for instance, the com- 
mon mold penicillium, which grows freely in its solutions. 
This same selective action is also observed in its effects on the 
ferments of the higher animals. Thus, in artificial experiments 
it has been found that while the gastric and pancreatic ferments 
are rendered less active by the addition of quinine, the drug has 
practically no effect on the action of ptyalin and diastase. In 
brief, from the results of careful experimental research it has 
been concluded that quinine hinders some, if not all, of the 
processes which normally occur in living matter and are ex- 
pressed in movement and various chemical products, and also 
that this action is not confined to the intact protoplasm, but 
extends to the ferments. In regard to the amount of its anti- 
septic power, most observers have found this equal to or greater 
than that of carbolic and salicylic acids, but considerably less 
than the salts of mercury and silver. About 0.2 per cent, solu- 
tions are antiseptic; this strength, it is stated, preventing acetic 
and butyric fermentations and the decomposition of albuminous 
substances. Some bacilli are quite susceptible to its influence; 
others, especially anthrax spores and the spirillum of relapsing 
fever, are found more refractory. 

Internal. Alimentary Canal. — Its chief action here is that 
of a vegetable bitter. The bitter taste is marked and pro- 
longed. The gustatory and gastric nerves are stimulated re- 
flexly, inducing more or less increase in the salivary and gastric 
secretions. It is, then, a stomachic tonic, promoting appetite 
and digestion. It is a question how far its antizymotic action, 
which if unrestrained would exert some slight retarding influ- 
ence on the gastric juice, and so tend to interfere with digestion, 
is really operative ; but it seems probable that this is more than 
counterbalanced by the reflex effects on the stomach and the 
mild stimulation of the gastric mucous membrane. In large doses 
it may cause nausea and vomiting. On the intestine quinine 
has no well-marked effects except it be given in large amount, 



132 PHARMACOLOGY AND THERAPEUTICS. 

when it acts as an irritant and may cause diarrhoea, which in 
exceptional instances may be characterized by bloody stools. 
The preparations of cinchona bark, owing to the presence of 
tannic acid, sometimes exercise an astringent effect upon the 
intestinal mucous membrane, and cause constipation. When 
taken into the stomach quinine is dissolved by the acid gastric 
juice, and quinine chloride is formed. If not promptly ab- 
sorbed, however, it passes into the intestine and is liable to be 
precipitated by the alkaline secretions, which form with it 
insoluble salts ; so that under these circumstances a consider- 
able portion of the quinine escapes absorption and is discharged 
in the faeces. 

Blood. — Quinine has been shown to have a special action upon 
the blood, which, however, is merely an illustration of its effects 
on the tissues generally. 

(a) White corpuscles. — When a small quantity is added to a 
drop of blood on the warm stage of the microscope it is ob- 
served that the normal changes in form and position of the leu- 
cocytes are at once stopped, while these cells become spherical 
in shape, darker in color and granular, and shortly disintegrate 
into debris. Similar results are observed in the mesentery of 
the frog when quinine is applied locally, and if the part be 
slightly irritated, so as to set up inflammatory action, the leuco- 
cytes do not accumulate in the tissues, as would be the case 
without the application of the drug; while if the quinine is 
applied after such irritation has been resorted to, the outpour- 
ing of the leucocytes through the capillary walls (diapedesis) 
is at once arrested. The same thing occurs when quinine is 
injected into the circulation, and the leucocytes, which assume 
a spherical form, are considerably diminished in number. 
While, however, these changes are due, no doubt, to the poison- 
ous action of the drug on the white corpuscles, it has been 
pointed out that it would be unjustifiable to infer from such 
experiments that quinine, in therapeutic doses, inhibits the 
movements of these cells in the human body. At the same time 
it is unquestionably true that in man ordinary quantities of qui- 



CINCHONA. I33 

nine, even when absorbed from the gastro-intestinal tract, have 
the effect of diminishing the number of leucocytes. 

(6) Red corpuscles. — On these it appears to have but little 
effect. It is true that certain observers have described an in- 
crease in size and others a destructive influence on the red cor- 
puscles, but it has been found that this does not occur under 
ordinary circumstances. It should be stated, however, that one 
authority-, as the result of observations made upon himself, 
arrived at the conclusion that quinine has a direct effect in 
increasing the number of the red corpuscles. 

(c) Other effects on the blood. — Quinine has additional ef- 
fects on the blood by reason of its action on processes attributa- 
ble to unorganized ferments. Thus, the addition of quinine to 
drawn blood prevents the acid fermentation which normally 
takes place in it as the result of the oxidation of certain un- 
known substances at the expense of the oxyhemoglobin, which 
it partially reduces. That quinine exercises an inhibiting influ- 
ence on the oxidizing action of the blood is shown by the fact 
that blood to which the drug is added fails to decolorize indigo 
or to form the blue oxidation product of guaiac. It therefore 
lessens the ozonizing power of the blood; but although the oxi- 
dizing energy of the latter is diminished, and oxygen is given 
off less readily, it has been found that the haemoglobin is appa- 
rently uninfluenced. Another action which is stated to be re- 
tarded by the presence of quinine is the coagulation of the 
blood. 

Heart and Circulation. — On the isolated frog's heart it is 
found that the action of quinine, which is entirely muscular, 
consists in slowing of the organ and a marked diminution in 
the strength of its contractions. In mammals it causes at 
first contraction of the arterioles and a quickening of the heart's 
action, which are followed by dilation of the vessels and a slow- 
ing and weakening of the cardiac contractions. These effects 
are believed to be probably due to the direct influence of the 
alkaloid on the muscular structure of the circulatory system, 
although by some the acceleration has been attributed to de- 



134 PHARMACOLOGY AND THERAPEUTICS. 

pression of the inhibitory mechanism in the heart or in the 
medulla. Accompanying the acceleration of the pulse there is 
a rise of blood-pressure, which seems to depend mainly on the 
vaso-constriction. It has been found that the pulse-rate in 
general follows the blood-pressure, but that during the fall it 
does not sink so rapidly and markedly as the pressure. In fatal 
poisoning the heart is stated to be generally very much weakened 
when the respiration stops, but continues to beat for some time 
afterwards. Quinine very frequently causes derangement of 
the sense of hearing and less commonly derangement of that of 
sight, which are believed to be due to vascular changes, rather 
than to any effect upon the brain. In the one case there are 
deafness and ringing in the ears and in the other defective 
color-vision, contraction of the visual field, and in some in- 
stances temporary blindness. The disorders of hearing are 
attributed to congestion of the auditory canal and those of 
sight to a very marked contraction of the retinal vessels, which 
may even be obliterated; but why quinine should produce these 
opposite vascular effects in the eye and the ear still remains 
unexplained. The congestion of the membrana tympani has 
been known to result in inflammation which caused permanent 
impairment of the hearing, and the constriction of the retinal 
vessels may be so severe as to cause degeneration of the gan- 
glion cells and ascending atrophy of the optic nerve. 

Respiration. — In moderate doses quinine slightly stimulates 
the respiration, but in large ones acts as a depressant. In ani- 
mals lethal amounts cause death through failure of the respira- 
tion. In exceptional instances quinine induces an asthmatic 
condition, characterized by a feeling of suffocation and rapid, 
noisy and irregular breathing. 

Cerebrum. — The activity of the brain is thought to be stimu- 
lated by small doses of quinine, which even seem to exhilarate 
in susceptible individuals. Large doses produce a sense of 
heaviness and fullness, with depression, confusion of ideas, hal- 
lucinations and difficulty of speech, and, in addition, there are 
sometimes observed giddiness or vertigo, uncertainty of gait, 



CINCHONA. 135 

and slowness of the pulse. The mental depression may deepen 
into melancholia or even dementia (which is generally cura- 
ble) ; while in some instances, instead of depression there is 
excitement, which may amount to mania. Collapse may follow. 
One effect of quinine on the cerebrum is of special interest from 
a therapeutic point of view, and that is the diminished appre- 
ciation of pain which is caused by it. By some the blindness 
and deafness resulting from large doses are thought to be prob- 
ably partly central in origin. From poisonous amounts of qui- 
nine administered to animals the only cerebral effects noted are 
said to be general depression and muscular weakness. 

Spinal Cord and Nerves: — In frogs quinine, in toxic doses, 
causes a temporary increase of reflex excitability, which is fol- 
lowed by the loss of spontaneous movements and paralysis of 
the spinal cord, as well as arrest of respiration. In mammals 
small quantities are said to have the effect of stimulating the 
spinal cord, which is afterwards depressed. It is stated that 
solutions of quinine when applied locally, even in sufficient 
strength to cause marked abnormalities in the muscular con- 
traction, do not lessen the irritability of the nerve trunks, and 
that no satisfactory proof has been offered that the alkaloid 
affects the peripheral ends of the motor or sensory nerves. 

Muscles. — Experiment shows that the strength of the contrac- 
tions may be increased as much as six times by moderate 
amounts of quinine, but the muscle is much more quickly fa- 
tigued than the unpoisoned muscle, so that its total work is less. 
As the same effect is observed in curarized muscle, it undoubt- 
edly depends upon a direct action on the muscle-fibre. Some- 
what stronger doses are found to lower the contraction from 
the beginning, while large quantities produce a rigor analogous 
to that caused by caffeine. Quinine thus acts upon muscle in 
the same way as upon the simpler organisms, at first augment- 
ing its energy and then weakening it. 

Uterus. — There is considerable evidence to show that quinine 
stimulates uterine contractions when labor has already com- 
menced. In some cases it also appears to increase the men- 



I36 PHARMACOLOGY AND THERAPEUTICS. 

strual flow, but it is improbable that it is capable of exciting 
abortion, as claimed by some. Its action in uterine inertia may 
perhaps be due in part to its action on unstriped muscle, such 
as it appears to have in the case of the arterioles, and in part 
to its effect in arousing the general nervous forces of the sys- 
tem. It tends to prevent post-mortem haemorrhage by causing 
contraction of the uterus. 

Urine. — Quinine has sometimes, but not constantly, the effect 
of somewhat increasing the amount of urine, an action which 
is thought to be due to its influence upon the renal epithelium, 
by which it is excreted. Quinine is found in the urine within 
half an hour after its ingestion by the mouth, and about one-half 
the quantity absorbed is stated to be excreted within six hours. 
After this its elimination takes place less rapidly, and traces 
may be discovered in the urine seventy-two hours after its in- 
gestion. Even in very small doses quinine has a pronounced 
effect on metabolism, or tissue change. In the excretion of 
nitrogen there is at first a slight increase and then a marked 
diminution, which, with large doses, may amount to 39 per cent. 
This is the result of the powerfully depressant action of qui- 
nine on the elimination of all the nitrogenous excretory prin- 
ciples, and especially urea and uric acid. In contrast to this, 
and somewhat contrary to what one would naturally be led to 
expect, is the slight influence of quinine upon the oxidation of 
the body; the quantity of oxygen absorbed and of carbon diox- 
ide given off being practically unaffected by even large medici- 
nal doses. While quinine is excreted chiefly through the kid- 
neys, it appears to be diffused from the blood to a limited ex- 
tent through various other channels, and has been detected in 
the tears, saliva, sweat and milk, as well as in the bile and in 
dropsical effusions. 

Temperature. — In the normal subject quinine sometimes has 
the effect of reducing the body temperature to a small extent. 
In other instances the temperature remains entirely unaffected, 
while in still others it undergoes a slight rise. As a rule, it 
may be stated, small doses cause this slight rise, while doses 



CINCHONA. 137 

considerably larger, but not sufficient to produce marked col- 
lapse, occasion an insignificant fall of temperature. In febrile 
conditions, however, it has a decided antipyretic effect, though 
not so marked as that of drugs of the antipyrine and salicylic 
acid classes. The fact that this action may be produced after 
division of the spinal cord shows that it does not depend upon 
any influence exerted upon the central nervous system, and it is 
now generally accepted that the temperature-reducing property 
of quinine is due to the direct action of the alkaloid upon the 
tissues. It is true that the excretion of carbon dioxide is gen- 
erally regarded as an index of chemical changes resulting in 
the liberation of energy and consequently of heat; but, while, as 
has been seen, quinine ordinarily does not seem to affect this 
to any appreciable extent, it is thought extremely probable that 
the antipyretic action of the drug is due to its retarding the 
metabolism. In support of this hypothesis it has been sug- 
gested that the presence of fever poisons throws the tissues into 
a state of augmented activity, in which they are more suscepti- 
ble to the sedative action of the drug, and that even in the nor- 
mal organism a reduction of the temperature might be induced 
if a sufficient quantity could be taken without exciting other 
symptoms. In this connection attention is called to the fact 
that in fever the nitrogenous decomposition is much increased, 
while quinine has a directly opposite effect; and it is pointed 
out that the diminution in the nitrogenous metabolism may 
also lead to an increased resistance being offered to the cause 
of the fever, or may lessen the poisonous products circulating 
in the blood. Furthermore, it is argued, the bacteria causing 
fever may themselves be rendered less active by the alkaloid, 
although this antiseptic action is probably of subordinate im- 
portance, since many of the pathogenic forms have been found 
to offer great resistance to it. Other authorities hold, some- 
what in the same line, that as it is an indubitable fact that the 
production of heat is diminished by quinine in fever, we are 
forced to the conclusion that oxidation or combustion (as shown 
by the excretion of carbon dioxide) is not the only source of 



I38 PHARMACOLOGY AND THERAPEUTICS. 

heat; that heat may also be liberated by other changes — by the 
splitting or hydration of nitrogenous molecules, in the course 
of which the nitrogen is converted into urea; and that these 
changes are those which are hindered by quinine. If then it 
be supposed that this form of heat production is, as seems prob- 
able, especially prominent in fever, the fact that quinine acts 
on febrile, and not on normal temperature, would also be ex- 
plained. 

Cinchonism is the name given to the train of symptoms to 
which doses of .60 gm. (10 gr.), or more, of quinine are liable 
to give rise. The most characteristic of these are a sense of 
fullness in the head, tinnitus aurium, and slight deafness. From 
larger amounts these symptoms may be augmented, and in addi- 
tion the patient may suffer from disorders of vision, sometimes 
amounting to blindness, and the severe cerebral disturbances 
which have already been mentioned. The susceptibility to the 
physiological effects of the drug differs very greatly in different 
individuals, and various idiosyncrasies as regards its influence 
have frequently been noted. Occasionally it is the cause of 
cutaneous eruptions, such as erythema, urticaria, herpes, pur- 
pura, etc., and instances have even been reported in which the 
affection was gangrenous. A peculiar rash has also been ob- 
served among workers in cinchona bark. A case has been re- 
corded in which .004 (-^ gr.) of quinine repeatedly produced 
an erythematous or bullous eruption, and .20 gm. (3 gr.) has 
been known to be followed by severe constitutional disturbance, 
hsematemesis and bloody stools. Gastro-intestinal irritation is 
not infrequently occasioned by comparatively small doses, and 
in a very few instances albuminuria and hematuria have re- 
sulted from it. Death from quinine is of extremely rare occur- 
rence. Enormous doses have sometimes been taken without 
peril to life, and it seems probable that in these cases a large 
proportion of the drug passed through the system without being 
absorbed. Hydrobromic acid has been found in many in- 
stances to prevent the ringing in the ears or headache caused 
by it, and from 2 to 7.5 c.c. (^ to 2 fl. dr.) of the diluted acid 



CINCHONA. I39 

may be given with ordinary doses of quinine. The bromides 
may also be used for this purpose, and ergotin likewise is said 
to diminish the liability to cinchonism. In respect to their 
effects on the brain, morphine and quinine are regarded as 
antagonistic, and in respect to their action on the sympathetic 
system, on the heart, and on the temperature, quinine and atro- 
pine. The latter drug is said to be successful in combating the 
annoying cutaneous effects sometimes caused by quinine. 

Relative Action of the Alkaloids. — The other alkaloids re- 
semble quinine very closely in their effects on the system, but 
are weaker in their action. Quinidine is most likely quinine, 
while cinchonine and cinchonidine differ from the latter in 
having a convulsant influence; in consequence of which the 
stage of stimulation in their action on the central nervous sys- 
tem is more marked. This tendency to produce convulsions, 
which are of an epileptiform character, is said to be much the 
more pronounced in the case of cinchonidine, which, but for its 
resemblance in other features to quinine, might, it is held, be 
classed among the convulsive poisons. The relative antipyretic 
effect of the alkaloids has been set down as follows: Quinine, 
100; quinidine, 90; cinchonidine, 70; cinchonine, 40. 

Therapeutics of Cinchona and its Alkaloids. 
External. — The expensiveness of quinine renders it unavail- 
able, as a rule, for antiseptic purposes. A one per cent, solution 
of quinine sulphate is sometimes used, however, as an applica- 
tion to unhealthy sores and infected wounds, and a five per cent, 
solution as a wash in diphtheria, an injection in otorrhcea, hay- 
fever, gonorrhoea and chronic cystitis, and an insufflation in 
whooping-cough. An attack of hay-fever, if the catarrhal irri- 
tation is confined to the nares and fauces, may in some instances 
be arrested by the topical application by means of a camel's-hair 
brush, or in the form of a spray, of a solution of quinine hydro- 
chloride (.25 to .50 gm. ; 4 to 8 gr. ; to 30 c.c. ; 1 fl. oz. of 
water). Powdered quinine sulphate, dusted upon chancroids, is 
said to promote rapid healing. 



I40 PHARMACOLOGY AND THERAPEUTICS. 

Internal. — G 'astro-intestinal Tract. — The preparations of cin- 
chona are used to a large extent in digestive troubles, especially 
when associated with a debilitated state of the system, and, if 
their administration is not maintained for too long a time, gen- 
erally serve an excellent purpose. In conditions such as atonic 
dyspepsia and gastric catarrh they may often be combined ad- 
vantageously with the mineral acids. They are contra-indi- 
cated in all inflammatory states of the gastro-intestinal mucous 
membrane, but where the latter is relaxed and there is more 
or less diarrhoea without inflammation, preparations of the red 
bark are likely to be of great benefit. In many cases the com- 
pound tincture, which contains other stomachics also, is to be 
commended. (The name of " Huxham's tincture" is often 
applied, incorrectly, to this preparation.) In the gastric catarrh 
of drunkards the alkaloid quinine, generally combined with 
acids, is considered of special service. Quinine is one of the 
most commonly used of all tonics, and in the small quantities 
required for this purpose may generally be continued for a very 
considerable time without causing any impairment of digestion 
or absorption. It is frequently given associated with iron, and 
is apt to be prescribed especially with the tincture of ferric 
chloride, the free acid in which readily dissolves it. Strychnine 
is also often added to combinations of quinine and iron, as in 
the official elixir, glycerite and syrup. The tonic dose of qui- 
nine sulphate or hydrochloride is from .03 to .12 gm. (^ to 
2 gr.), and the latter salt is not infrequently preferred to the 
sulphate on account of its greater solubility. In many in- 
stances both as a tonic and an antiperiodic, cinchonidine salicyl- 
ate (not official) is preferable to quinine sulphate, and may 
be prescribed in doses of from .30 to .60 gm. (5 to 10 gr.). 

Antipyretic Effect. — While quinine was formerly much in 
vogue as an antipyretic, at the present time, except in the case 
of malarial fever, it is seldom employed in this capacity, since 
in the comparatively rare instances where it is deemed advisa- 
ble to reduce the temperature by means of drugs this can be 
much more certainly and efficiently accomplished by the coal- 



CINCHONA. 141 

tar derivatives, such as antipyrine, phenacetine and acetanilide. 
Where for any reason it is desirable to use quinine in febrile 
conditions for this purpose it should be given preferably in a 
single dose of from 1.20 to 2.40 gm. (20 to 40 gr.) for an adult. 
It may be administered in tablets or capsules, suspended in milk, 
or in solution. For dissolving the hydrochloride only water, in 
sufficient quantity, is required, but in the case of the sulphate 
it is necessary to add acid. With these large doses it is ad- 
visable to give sodium or potassium bromide, in order to avoid 
the disagreeable tinnitus which is likely to be set up by the 
drug. The diluted hydrobromic acid is an excellent solvent, 
and, at the same time, will relieve the ringing in the ears. In 
a considerable proportion of cases the antipyretic action of 
quinine may be relied upon, and, like the other antipyretics, it 
will be found most efficient at a time when the temperature has 
a natural tendency to fall. Usually about two hours elapse 
before the antipyretic effect manifests itself, and it should 
therefore be given at that interval before an expected decline 
in temperature. Quinine, it is worth noting, possesses the 
advantages over the coal-tar antipyretics of a more prolonged 
action and of exposing the patient to much less risk of collapse. 
It is therefore still prescribed to some extent in surgical fever. 
Specific Action. — One of the most positive effects in the whole 
range of Medicine is that of quinine, and to a less pronounced 
degree the other alkaloids of cinchona, in arresting the parox- 
ysms of malarial fever. It is now known that this result is 
due to the directly poisonous action of the drug upon the Plas- 
modium malariae, which infests the blood and is the specific 
cause of the disease. Outside the body a 1 to 10,000 solution of 
quinine will immediately arrest the movements of the hsemato- 
zoon, and the same thing is found to occur when the alkaloid 
is circulating in the blood. Here it prevents the entrance of 
the spores into the red-corpuscles, in which their cycle of 
development solely takes place. About three hours after the 
administration of quinine by the mouth it is stated that the 
erdoglobular forms met with in tertian and quartan fever be- 



142 PHARMACOLOGY AND THERAPEUTICS. 

come immobile and granular, and lose their affinity for certain 
stains; while several hours later they may be seen deformed 
and segmented. Experimental research has shown that quinine 
does not act equally on the parasite in all its stages; its most 
powerful effect being upon the forms which are just breaking 
into spores and upon the free-swimming organisms, while its 
action is much weaker upon the older segmenting bodies, and 
least upon the young endoglobular forms. Since it has been 
found that these last exist in the blood just before the paroxysm, 
their sporulation giving rise to the characteristic chill with its 
ensuing febrile reaction, quinine, on account of the inefficiency 
of its action upon them, will have little or no effect in counter- 
acting the paroxysm then impending. If, however, it is given 
at this time it will, it is argued, be present in the blood when 
the spores are liberated, and as these, as has been seen, are most 
susceptible to its action, it will be able (if the quantity adminis- 
tered has been sufficiently large) to destroy them, and thus 
prevent the development of the new cycle. It is advisable, 
therefore, that the alkaloid should be given several hours be- 
fore the expected paroxysm, so as to allow time for absorp- 
tion. The powerful destructive action which quinine exerts 
on the malarial parasite, both in and outside the body, is ex- 
actly the same as that which is observed in the case of amoebae 
and other similar forms. It is explained by the effects of 
the alkaloid as a protoplasmic poison, by virtue of which it acts 
more strongly (specifically) on the lower forms of life than on 
the higher, and hence can be introduced into the human body 
with perfect safety in quantities which are sufficient to destroy 
such simple organisms. In addition to this direct action, it is 
held by some that quinine has an indirect action, manifesting 
itself in an alteration of the environment, in consequence of 
which the latter is rendered less favorable to the growth of 
the parasite. As an example of this is cited the diminished 
readiness with which the red blood-corpuscles part with their 
oxygen after the addition of quinine. Both theory and experi- 
ence, it has been observed, point to the decline of the fever as 






CINCHONA. I43 

the most advantageous time for the administration of the drug. 
Some prefer to give a single large dose (usually about 1 gm. ; 
15 gr.), and others divided doses, of about .30 gm. (5 gr.), at 
intervals between the attacks. Since the elimination of quinine 
takes place with considerable rapidity, the maximum curative 
effect is believed to be obtained by the administration of the 
whole amount required in one dose, rather than by a succession 
of small doses. As the result of a very extended observation 
one of the best authorities on this subject states that according 
to his experience the most effective method of treating an inter- 
mittent is to give a full dose of quinine (.60 gm. ; 10 gr.) in the 
sweating stage, and the same quantity five hours before the time 
of the next paroxysm. He has also found that the anti-periodic 
property of quinine is increased, while the cerebral effects of 
large doses are diminished, by combination with morphine. If 
in any case a very prompt effect is desired, from 1 to 2 gm. (15 
to 30 gr.) of quinine carbamide (not official), which is very 
soluble, may be administered hypodermatically ; a smaller dose, 
.30 to .50 gm. (5 to 8 gr.) in an hour or two, is almost in- 
variably successful in preventing the next immediate chill. 
After the paroxysms have been overcome the remedy should 
not be entirely abandoned, but, for at least three weeks, on the 
seventh day from the date when the last one appeared full 
cinchonism should be produced, by the use of from .60 to 1 gm. 
(10 to 15 gr.) of quinine; as the attacks show a decided tend- 
ency to recur in cycles of seven days. It has been found that 
the action of quinine is materially assisted by the continuous 
administration of arsenic during the intermissions, and until the 
third septenary period has passed. Quinine is both curative 
and prophylactic, and it has in numberless instances been 
proved that its regular administration in very moderate quan- 
tities (from .20 to .30 gm. ; 3 to 5 gr. a day) will absolutely or 
to a large degree protect persons living in malarious regions 
from ague. If the malarial poison is concentrated and active, 
and the conditions are otherwise unfavorable, the amount 
should be doubled; and it is to be noted that an enormous ex- 



144 PHARMACOLOGY AND THERAPEUTICS. 

perience has now shown that the drug when taken thus as a 
prophylactic is entirely free from injurious effects. In re- 
mittent fever the best plan of administration is to give from 
1.20 to 2 gm. (20 to 30 gr.) of quinine in a single dose once or 
twice each day until the temperature is reduced to normal. 
In the pernicious variety of malarial fever the patient's life 
is in imminent danger, and not only are large doses of quinine, 
from 1.20 to 3.60 gm. (20 to 60 gr.) demanded, but they must 
be given promptly; so that administration by the stomach, 
rectum and hypodermatic injection may be in turn or simul- 
taneously practiced. In any severe attack of ague Clark's pow- 
der, which consists of quinine, 10; powdered capsicum, 4; 
powdered opium, 1 part, may be resorted to. This is usually 
given in 1.00 gm. (15 gr.) doses, and is said to be more effica- 
cious in the treatment of the disorder than larger doses of 
quinine when given alone. In chronic malarial infection quinine 
is less curative than in the acute; the principal reason for this 
probably being the presence of certain structural alterations re- 
sulting therefrom in the liver, spleen, kidneys, intestines or 
central nervous system. Here quinine salicylate and cinchoni- 
dine salicylate are said to be especially effective, and they may 
often be combined advantageously, according to circumstances, 
with iron, arsenic or cholagogue cathartics such as the prepara- 
tions of podophyllum. When an individual has once suffered 
from malaria any subsequent affection which he has is apt to 
assume a malarial type. This is especially true of neuralgia, 
which is often located in the forehead and has received the 
name of "brow-ague." It generally yields promptly to quinine, 
which is also sometimes of service in neuralgias not of ma- 
larial origin. Not only superficial neuralgias in various por- 
tions of the body, but also neuralgic pains in any of the deep- 
seated organs, may be an expression of the malarial cachexia 
as affecting the sensory nervous system ; while its influence 
on the motor apparatus may be shown by such disorders as 
chorea, epilepsy, asthma, hiccough, laryngismus stridulus, and 
spasmodic stricture of the urethra. These neuroses, it has 



CINCHONA. 145 

been found, may either be substituted for the ordinary malarial 
paroxysm (chill, fever and sweating) or may assume a period- 
ical character in consequence of having occurred in a system 
already affected with malaria. They are to be distinguished 
from other functional nervous- affections by the more uniform 
periodicity in the recurrence of the paroxysms, and if the 
patient is known to have previously suffered from malarial in- 
fection the diagnosis is usually simple. In the case of ma- 
larial neuralgias particularly, morphine is of material service as 
an adjunct to the action of quinine. Malarial diarrhoea, dysen- 
tery and jaundice may sometimes be promptly relieved by 
quinine, but if these depend on structural alterations in the liver 
or the intestinal glands they are naturally more intractable. 
Hsematuria of malarial origin usually requires large doses of 
the remedy. Warburg's tincture is a remedy which has long 
enjoyed a considerable reputation in the treatment of malarial 
infection, especially in the tropics. It contains quinine sul- 
phate, 80; Socatrine aloes, 100; opium. 1; rhubarb, 32; cam- 
phor, 8; with a number of aromatics and menstruum to 4000. 
The proportion of quinine is about .60 gm. (10 gr.) to 30 c.c. 
(1 fl. oz.) of menstruum, and the dose is 4 to 15 c.c. (1 to 4 
fl. dr.). It may now be obtained in tablets, each of which rep- 
resents 4 c.c. (1 fl. dr.) of the preparation. In many instances 
Warburg's tincture is prescribed without the aloes. In enlarged 
spleen (ague-cake) and in conditions, such as malarial jaundice, 
where there is great irritability of the stomach or of the in- 
testinal mucous membrane, as well as in all cases where it 
becomes necessary to secure the promptest possible effect, it is 
advisable that quinine should be administered subcutaneously. 
The simple alkaloid and quinine sulphate are not adapted for 
this purpose, as they produce too much irritation, and have even 
been known to give rise to tetanus; and hence it is requisite to 
use some more soluble preparation of quinine, such as quinine 
carbamide (quinine urea), hydrochloride, kinate, or sulpho- 
vinate. 
Other Uses.— Quinine has been employed in a great variety 
11 



I46 PHARMACOLOGY AND THERAPEUTICS. 

of conditions besides those already mentioned, and in many of 
them with good results. There is no question of its distinct 
value in the treatment of whooping-cough, which there is good 
reason to suppose is a microbic disease. In order to get the 
full benefit of its remedial agency, however, it should be slowly 
swallowed in solution, so that it may act locally on the mucous 
membrane of the fauces as well as produce an internal effect; 
and given in this way its intensely bitter taste proves an almost 
insuperable objection, as it is extremely difficult to get children 
to take it. Still, in other forms it has been found of consider- 
able service by a number of observers. It may therefore be 
given in capsules or combined with chocolate or administered 
by the rectum in suppositories or enemata. It is advised that 
in the case of an infant under one year the treatment should 
be commenced with as many centigrammes as its age in months, 
and that older children should take daily as many decigrammes 
as their age in years. In no case, however, should the amount 
taken in a single day exceed 1.5 gm. (23 gr.). To children 
the tannate is not infrequently given, as it is practically taste- 
less, and made into tablets with chocolate is readily taken. As 
it contains much less quinine, the dose should be twice as large 
as the sulphate. In influenza, quinine, either alone or combined 
with other remedies, has been used with some success, and it 
is also claimed that it is of value as a prophylactic in this dis- 
ease. When an attack has commenced it is said that its early 
administration tends to prevent or diminish cardiac complica- 
tions, as well as other complications and sequelae. In certain 
cerebral affections it is of decided benefit. In the case of el- 
derly people it improves the intra-cranial circulation, and so 
relieves a group of symptoms depending on sluggishness of the 
latter which has been described as follows: Headache, vertigo, 
failure of memory and despondency, associated with a slow 
pulse, an atheromatous degeneration of the vessels, puffiness of 
the eyelids, and dilatation of the superficial veins of the head. 
In the adynamic form of delirium tremens small doses of qui- 
nine are of service in tranquilizing the patient, and in the pre- 



CINCHONA. 147 

liminary stage of the affection known as " the horrors " has 
been found useful, especially when combined with a mineral 
acid, by correcting the digestion and invigorating the cerebral 
motor centres. In some forms of insanity, and particularly the 
puerperal variety, where there is much weakness and the sur- 
face is cold and clammy, quinine is also likely to prove beneficial. 
In headache and in neuralgias in various localities, as well as in 
chorea and epilepsy which are not dependent upon a malarial 
cachexia, it may prove useful, provided that anaemia is present 
and lies at the seat of the nervous derangement; but not other- 
wise. The laryngismus stridulus to which rachitic children are 
subject is said to be ameliorated especially by quinine hydrobro- 
mide. As an adjuvant to other treatment, quinine is of value 
in adynamic diseases, such as diphtheria and in surgical affec- 
tions, where it aids in sustaining the vital powers and tends 
to check the formation of pus ; as well as in cutaneous diseases 
like erysipelas, erythema nodosum, ecthyma and 'impetigo, 
where there is an enfeebled condition of the system. A com- 
mon cold may often be successfully aborted by the adminis- 
tration of .60 gm. (10 gr.) of quinine with .03 gm. ( T / 2 gr.), 
or less, of morphine at the onset of the attack. Quinine has 
also been found of service in asthma and hay-fever after the 
subsidence of the acute symptoms, in chronic bronchitis with 
bronchorrhcea, and in the night-sweats of pulmonary tubercu- 
losis. For the latter, doses of from .90 to 1.20 gm. (15 to 
20 gr.) are required. A full dose is frequently given previous 
to the passage of the catheter or urethral sound, in order to 
prevent the occurrence of a chill. Quinine is found useful by 
obstetricians in promoting uterine contractions after labor 
has once commenced, and is also thought to materially reduce 
the danger from sepsis. As an emmenagogue in anaemic sub- 
jects it is often combined with iron, and iron and quinine 
citrate is a good preparation for this purpose. There are 
certain classes of cases in which quinine should, if possible, 
be avoided. Among these may be mentioned : Idiosyncrasy, 
in consequence of which quite small doses produce very severe 



I48 PHARMACOLOGY AND THERAPEUTICS. 

cinchonism, acute or subacute disease of the middle ear, gastro- 
intestinal irritation, meningitis, and inflammation of the genito- 
urinary tract. 

Division II. — Drugs Acting on the Blood. 
A. Drugs Acting on the Plasma. — Substances of various kinds 
are capable, after absorption, of existing in solution in the 
plasma, and those which act as purgatives, diuretics and dia- 
phoretics must necessarily alter the composition of the plasma 
by abstracting substances from it. The object for which drugs 
are given to act on the plasma is to increase its alkalinity. 
Were it even desirable to render it acid, no agent is at present 
known which is able to accomplish this, or even to reduce to 
any extent the natural alkalinity of the plasma. The mineral 
acids, as is well known, can exist in it only in the form of 
neutral salts. 

The alkalizers of the plasma are salts of — 

(1) Potassium. (4) Lithium. 

(2) Sodium. (5) Magnesium. 

(3) Ammonium. (6) Calcium. 

This is approximately the order of their alkalizing power, potassium 
being undoubtedly the most powerful, while calcium is very feeble. 

It has been found that in the plasma the decomposition of the 
citrates and tartrates of these metals into alkaline carbonates 
takes place, and one of the purposes for which alkalies are 
administered is to cause, if possible, the formation of soluble 
urates by their combination with uric acid. Furthermore, the 
excretion of the urates is promoted by the diuretic action of 
the alkalies. 

Therapeutics. — Alkalies are consequently ver.y largely em- 
ployed in the treatment of gouty conditions, which are charac- 
terized by an excess of uric acid or an analogous substance 
in the plasma. Lithium preparations have been regarded by 
many as especially beneficial in such cases, but there is no rea- 
son to suppose that this is a fact, particularly as the solubility 



DRUGS ACTING ON THE BLOOD. 1 49 

of the urates is not increased by lithium. What is important 
is that the preparation selected should be one that is not apt 
to disturb the digestion, since the remedy must usually be 
continued for a considerable period; hence potassium citrate 
and lithium citrate are favorite salts, and the numerous natural 
alkaline waters are also very largely used. No doubt, one 
of the chief services which the latter render is the flushing 
of the system with a large amount of fluid. 

On the hypothesis that acute articular rheumatism is due 
to a materies morbi of the plasma (by many believed to be lactic 
acid), which is generated within the body, large doses of the 
alkalies were long given in this and other affections involving 
a so-called rheumatic diathesis, with the idea of neutralizing 
and eliminating such morbid principle from the blood. This 
treatment, however, has now been practically supplanted by 
the use of salicylic acid and its compounds. 

In chronic lead poisoning potassium iodide has been and is 
still almost universally employed. It has been supposed to 
promote the elimination by the kidneys of the lead, which 
accumulates in the tissues in a very sparingly soluble form, 
though it has now been denied that this salt has any effect 
on its excretion either by the urine or the intestine, by which 
most of the lead is known to make its escape from the body. 

Purgatives, diaphoretics and diuretics necessarily have the 
effect of altering the composition of the plasma, and hence are 
frequently employed in the treatment of local or general 
cedema and of effusion into serous cavities, for the purpose 
of draining off fluid from the plasma. They are also used to 
facilitate the excretion of poisons from the blood in conditions 
such as uraemia and cholsemia. Venesection, transfusion and 
the intravenous injection of watery solutions naturally alter 
the composition of the plasma directly. 

B. Drugs Acting on the Red Corpuscles. — The most impor- 
tant are those which are capable of increasing the amount of 
haemoglobin. It is a fact, however, that there are no known 
drugs which will increase the amount of iron in perfectly 



I50 PHARMACOLOGY AND THERAPEUTICS. 

healthy blood; hence, in a strict sense, the action of all such 
agents much be regarded rather as a pathological than a physi- 
ological one. These drugs are called Haematinics. 



They are — 

(1) Iron and its salts. 

(2) Arsenic trioxide. 

(3) Potassium permanga- 

nate (doubtful). 



(5) Hydrochloric acid 
(4) Copper salts 

(6) Potassium salts 

(7) Phosphorus 



M doubtful). 



They increase the quantity of haemoglobin in each red cor- 
puscle, as well as the number of these corpuscles. Their effects 
are materially assisted by all measures which tend to improve 
the digestion and the general health. The mode of action of 
these haematinics is still obscure, and will be discussed under 
each drug. Iron is by far the most important and efficient. 

Indirect haematinics are drugs which are of service by re- 
moving some obvious cause for a deficiency of haemoglobin 
(the condition known as anaemia), such as mercury, given 
for syphilis, quinine, for ague, etc. 

Alcohol and quinine slightly diminish the oxygenating power of the 
blood by increasing the stability of the oxyhemoglobin. Citrates and 
tartrates of the alkaline metals are partially oxidized to carbonates at 
the expense of the oxygen of the red blood-corpuscles. 

The red blood-corpuscles are believed to be increased in size by oxy- 
gen and hydrocyanic acid, and to be rendered smaller by morphine and 
carbon dioxide, as well as by quinine, when, with a high temperature, as 
is probably the case, they are a little larger than normal. By small doses 
of mercury they are said to be increased in number. 

In consequence of the presence of a large amount of sodium chloride, 
the red corpuscles pass rapidly through the walls of the capillaries. 

Quinine and hydrocyanic acid diminish the ozonizing power of the 
blood. 

Certain drugs destroy life by altering the composition of the 
haemoglobin, and so preventing it from uniting with oxygen. 
Whatever their therapeutic effects, they are therefore of consid- 
erable importance from a physiological and toxicological point 
of view. Thus, carbon dioxide expels the oxygen from oxy- 



DRUGS ACTING ON THE BLOOD. I 5 I 

haemoglobin; hydrocyanic acid forms cyano-haemoglobin ; potas- 
sium chlorate, the nitrites, especially amyl nitrite, and most of 
the antipyretics (antipyrine and its compounds excepted) con- 
vert the haemoglobin into methaemoglobin ; acetanilide, amyl 
nitrite, potassium chlorate and pyrogallic acid destroy the red 
corpuscles. 

Phosphorus, arsenic, hydrogen sulphide, turpentine, iodine, and sul- 
phur also reduce oxyhemoglobin. 

Hydrocyanic acid, alcohol, chloroform, quinine, morphine, nicotine, 
strychnine and brucine have the effect of diminishing the oxidation of 
freshly drawn blood which is exposed to the air. 

C. Drugs Acting on the White Corpuscles. — Normally the 
white corpuscles undergo constant changes of form and position 
exactly similar to those of the amoeba, and it is found that gen- 
erally those drugs which are poisons to the amoebae are, when 
applied in sufficient concentration (which is rarely the case 
in the human body), toxic to the leucocytes. All irritants 
which set up inflammatory action have the effect of causing 
the passage of white corpuscles through the capillary walls; 
while all the cinchona alkaloids, and especially quinine, have 
the property of arresting this migration. Berberine sulphate 
and acetanilide act in a similar way. 

Veratrine destroys white co'rpuscles when applied to them outside the 
body. 

Camphor, myrrh and other aromatics are said to increase their pro- 
duction by increasing absorption from the intestine, while quinine, it 
is asserted, diminishes their number in the blood. 

A few other facts relative to the action of certain drugs 
upon the blood may be noted. Poisonous doses of mercury 
increase the fluidity of the blood, impair its coagulability, and 
diminish its solids. Phosphorus may also prevent the blood 
from clotting as readily as usual, and sometimes may cause it 
to remain fluid for forty-eight hours or more, but this is 
thought to be probably secondary to changes produced in the 
intestine and liver, rather than a direct effect of the poison. 



152 PHARMACOLOGY AND THERAPEUTICS. 

Various astringents and calcium salts (especially the chloride), 
on the other hand, promote coagulation. Cod liver oil in- 
creases the solids of the blood. 

A. Drugs Acting on the Plasma. 
POTASSIUM. 

1. POTASSII HYDROXIDUM (Potassa, U. S. P., 1890).— Potas- 
sium Hydroxide. (Potassa. Potassium Hydrate. Caustic Potash.) 

Preparations. 
Liquor Potassii Hydroxidi (Liquor Potassae, U. S. P., 1890). 
— Solution of Potassium Hydroxide. (Solution of Potassa.) 
Dose, 1 c.c; 15 n\. 

Liquor Cresolis Compositus. — Compound Solution of Cresol. 

Unofficial Preparations. 
Potassa Cum Calce (U. S. P., 1890). — Potassa with Lime. 
(Vienna Caustic. Vienna Paste.) 

Potassa Sulphurata (U. S. P., 1890). — Sulphurated Potassa. 
(Liver of Sulphur.) 

Action of Potassium Hydroxide. 

In the hydrates and carbonates of the alkalies the action of 
their basic metallic constituents is now known to be of little 
practical importance, the alkalinity of the substance mainly de- 
termining its pharmacological effects. The metallic ion serves 
for the most part as merely the means of applying the non- 
metallic constituent. It is incorrect, therefore, to regard potassa 
as typifying the action of potassium on the system. The in- 
fluence of the potassium ion is much more evident in other 
salts, and notably the chloride, in which the Cl-ion is quite 
inactive, while the K-ion is the energetic constituent. 

Action of Potassium Salts in General. — In the salts of the 
latter character it is seen that potassium has a distinctly 
toxic action, the principal effects of which are depression of the 
central nervous system and of the heart. That the heart is 



POTASSIUM. I53 

injuriously affected by the potassium salts in large amount is 
shown by the pulse becoming much slower and weaker and 
by a sudden fall of arterial pressure. In animals, when these 
salts are injected into the circulation, the cause of death is 
cardiac failure. But while in cases of poisoning by quantities 
far in excess of therapeutic doses the special toxic action of 
potassium upon the heart may, no doubt, have an important 
share in bringing about the fatal result, the effects noted are 
in many instances believed to be due to the action of the poison 
upon the alimentary canal. Upon the brain and the motor and 
sensory nerves, and upon the spinal cord especially, as well 
as upon the heart and the muscles in general, potassium salts 
exert a pronounced depressant influence. In poisoning by 
them in the frog the central action is shown by the spontaneous 
movements becoming weak and slowly performed, while in 
mammals the chief nervous symptoms are great muscular weak- 
ness and apathy. The respiration, it is stated, becomes rapid 
and labored, probably from the anaemia of the centres, and death 
in often preceded by weak and asphyxial convulsions. 

It is a fact, however, that when administered in ordinary 
medicinal doses these salts are not at any time present in the 
blood (owing to the rapidity of excretion) in sufficient quanti- 
ties to produce marked toxic effects, such as are observed when 
they are injected directly into the circulation of animals. Their 
poisonous action upon the heart has given rise to exaggerated 
apprehensions of the danger of using them in therapeutics, and 
it should therefore be borne in mind that only very large quanti- 
ties have any effect at all upon the heart, especially when given 
by the mouth. In this connection it has been pointed out that 
very much larger quantities of potash are taken daily in the 
food by thousands of persons than are ever prescribed in medi- 
cine, the amount of it in the food of some classes being esti- 
mated at from 50 to 100 gm. (i 1 /? to 3 oz.) per day. Still, the 
possibility of causing undesirable cardiac depression when 
potassium salts are given in large and long-continued doses 
should lead to a certain amount of caution in their use, and 



154 PHARMACOLOGY AND THERAPEUTICS. 

especially in the case of persons suffering from cardiac disease. 
It is also well to remember that when administered in con- 
siderable quantity for an extended period they are likely, as 
has been found, to have the effect of dissolving out the haematin 
from the red corpuscles, and so produce a dyscrasia, with im- 
poverishment and excessive fluidity of the blood. 

External. — In concentrated form potassium hydroxide has a 
powerful irritant and caustic action, partly in consequence of its 
combining with the water of the part to which it is applied. In 
addition, it combines with the tissue elements to form alkaline 
albuminates, and with the fats to form soaps. In this way it 
dissolves the skin and produces necrosis of the deeper tissues. 
The surface generally becomes coated with a semitransparent 
crust, and this eschar is subsequently separated by inflammation 
from the uninjured parts, leaving an ulcer. As potash forms 
soluble compounds with the proteids, it is only slowly neutralized 
by the tissues, so that it penetrates more readily than many other 
corrosives. In weak solution it thoroughly cleanses the skin 
by dissolving the superficial layer of the stratum comeum and 
the oily secretions of the glands, but if applied for some time 
it penetrates more deeply and may excite slight irritation and 
redness. On the mucous membranes it effects solution of 
mucus. Very dilute solutions apparently have a sedative effect; 
strong solutions destroy all living tissues with which they come 
in contact. 

Internal. Alimentary Tract. Mouth. — It has the character- 
istic alkaline taste of the hydrates and carbonates. In very 
weak solution it simply causes a reflex flow of saliva. In more 
concentrated form it dissolves the mucous secretions and the 
superficial layers of the lining membrane, the irritation chang- 
ing to a bright red the lips, tongue and general surface of the 
oral cavity, which feel soapy to the touch. Still stronger solu- 
tions have, as on the skin, a powerful escharotic effect, which 
extends to the throat and oesophagus, and may either prove 
immediately fatal or give rise to subsequent cicatrization and 
stenosis. The accidental swallowing of caustic alkalies is prob- 






POTASSIUM. I55 

ably the most frequent cause of cicatricial stricture of the 
oesophagus. 

Stomach. — As in the oesophagus, concentrated solutions pro- 
duce an amount of corrosion sufficient to destroy life in a short 
time, or which may be followed subsequently by gastric ulcer or 
scar-formation. They may prove immediately fatal by causing 
perforation into the peritoneal cavity. Small quantities of the 
drug appear to be soon neutralized by the hydrochloric acid of 
the gastric juice, and act no longer from their alkalinity, but 
merely from their effects as a salt, if at all. Larger quantities 
render the contents of the stomach neutral or alkaline, diminish 
the activity of the pepsin, and tend to prevent gastric diges- 
tion. It has been demonstrated that the alkalies have no effect 
whatever on the activity of the secretory glands of the stomach, 
while, on the other hand, they may affect the juice already 
secreted by making it neutral, or even alkaline, and thus com- 
pletely interfere with its usefulness. In hyperacidity of the 
stomach, however, they may prove of benefit by lessening the 
amount of free acid present. 

Intestines. — It is thought to be absorbed in combination with 
proteids or as a carbonate, and disappears rapidly from both 
the stomach and small intestine. In the latter it is found to 
have an indirect effect, in consequence of its diminishing the 
acidity of the gastric juice. Hence the secretion of the pan- 
creas, which is normally stimulated by the acid fluid passing 
from the pylorus, is materially lessened. While, however, this 
again may render digestion less complete, the greater alkalinity 
of the intestinal contents no doubt tends to increase the effi- 
ciency of the pancreatic juice already secreted. Contrary to 
what was formerly believed, it has been conclusively shown that 
alkaline salts do not increase the secretion of bile, are not ex- 
creted in it, and do not cause any change in its reaction. It 
is therefore inferred that any effect which these may exert in 
affections of the liver are due to their effects in the duodenum. 
In therapeutic doses they apparently have no effect on intesti- 
nal putrefaction, but it is stated that very large quantities (15 



I56 PHARMACOLOGY AND THERAPEUTICS. 

gm. ; y 2 oz.) increase the putrefaction, in consequence prob- 
ably of their neutralizing the disinfectant gastric juice. 

Blood. — It is believed to exist in the blood chiefly as the car- 
bonate. The alkalinity of that fluid, like that of the body in 
general, is increased; but the organism rapidly frees itself from 
the excess of alkali by excreting alkaline salts. It is stated that 
the blood of rabbits treated with alkalies is more strongly ger- 
micidal than usual, and that under these circumstances the ani- 
mals show an increased resistance to infection with anthrax 
bacilli. 

Respiratory Passages. — The bronchial secretion appears to 
be increased in quantity and also rendered less viscid. Mucin 
is more soluble in alkaline media, so that the alkalies dissolve 
any accumulations of mucus or make them more fluid. 

Nervous System. — Among the effects, in addition to those 
of its corrosive action in the alimentary tract, which caustic 
potash causes from the destruction of the tissues with which 
it comes in contact, the reflex influence on the central nervous 
system is of great importance. In consequence of this, when 
the dose is large, shock may appear so rapidly and be of such 
violence as to completely overshadow the local symptoms, and 
death may occur from cardiac paralysis before these have had 
time to develop. 

Urine. — The secretion of urine is increased, partly in con- 
sequence of the salt-action and partly, apparently, as the re- 
sult of an irritant effect upon the renal epithelium. The abso- 
lute amount of all salts excreted is increased, although their 
percentage is naturally lessened. The urine is temporarily ren- 
dered less acid or even alkaline. It generally soon regains its 
acidity, but under the use of repeated doses of sufficient amount 
its reaction may be kept alkaline indefinitely. Excretion takes 
place chiefly by the urine. 

Metabolism. — In view of the fact that outside the body cer- 
tain substances undergo oxidation much sooner in alkaline solu- 
tion than when neutral, and also on account of the importance, 
as regards their functions, of the alkaline reaction of the tissues. 



POTASSIUM. 157 

it might be' expected that an increase in the alkalinity of the 
fluids of the body would have the effect of increasing oxida- 
tion and promoting the general metabolism. There is, how- 
ever, no direct evidence that this is the case, and it is now 
recognized that the alkalies have less influence upon tissue- 
change than was formerly believed. The change in reaction, it 
is pointed out, can only be very brief, and is apparently not 
marked enough, or not of such a nature, as to be capable of 
demonstration by methods at present available. According to 
the observation of the best authorities the excretion of urea 
is sometimes increased and sometimes diminished, the explana- 
tion of this probably being that the local action of the alkali 
on the alimentary tract sometimes causes an increased forma- 
tion and destruction of the white corpuscles of the blood, and 
thus increases the uric acid. Some of the most reliable ob- 
servers have found that very large doses decrease the amount 
of the latter in the urine, while smaller ones have no effect on 
it. As regards the oxidation in the tissues, it is concluded that 
the amount of tissue waste is but little affected by the increased 
alkalinity of the blood, and that the slight changes observed 
may vary not only in different species, but in different persons, 
and even in the same person at different times. The cause of 
this individual variation is attributed either to difference in the 
amount of acid formed in the tissues or to differences in the 
local effect of the alkalies in the alimentary tract. 

Therapeutics of Potassium Hydroxide. 
External. — Caustic potash was formerly employed to make 
issues. It is sometimes used in the destruction of lupus car- 
cinomatous growths, etc., but its effects are somewhat difficult 
to limit, and great care should be taken in its application. On 
account of the thorough and penetrating character of its eschar- 
otic action it is to be preferred when a very deep and decided 
influence is desired, as after the bite of a venomous snake or 
rabid dog. For cauterizing morbid or cicatricial tissue it is 
often best to employ it in the form of Potassa cum Calce, which 



I58 PHARMACOLOGY AND THERAPEUTICS. 

is milder in its operation and more manageable than pure 
potassa. In using it it is generally first reduced to a paste 
with a little alcohol, its action being limited laterally by means 
of adhesive plaster and in depth by the duration of the applica- 
tion. After the withdrawal of the caustic, diluted vinegar 
may be applied in order to neutralize any alkali that may remain, 
and this is sometimes followed by a poultice. It is often of ser- 
vice in phagedena. Caustic potash is employed after operations 
for the cure of fistula, for the purpose of preventing immediate 
union. It also proves a very satisfactory agent in the treat- 
ment of ingrowing toe-nail. The portion of nail to be removed 
is painted with a 40 per cent, solution of it, with the effect of 
rapidly softening its upper layer to such an extent that it can 
be readily scraped off. This procedure is repeated until the 
nail which remains is only a thin scale, which can be excised 
with fine scissors. Liquor Potassii Hydroxidi may be employed 
to dissolve oily secretions and thoroughly cleanse the skin before 
operations, and, diluted, is sometimes used to remove the epider- 
mis in some forms of chronic cutaneous disease. In like man- 
ner it softens callosities, such as corns and bunions, resulting 
from the effects of local pressure. In sufficiently weak solution 
its sedative influence tends to allay itching, and the following 
combination has been found efficient in pruritus: Solution of 
potassium hydroxide, 4; phenol, 4 to 8; flaxseed oil, 30. 

Internal. — Potash is not often used internally, except at 
times as an antacid for the relief of acid dyspepsia. It has 
been claimed that it is sometimes successful in reducing obesity, 
a result attributed to its stimulation of the processes of meta- 
bolism, with consequent increased oxidation of proteids and 
fats ; but it seems more probable that in cases of this kind it 
acts by slowly poisoning the patient, producing disorganization 
of the blood and interfering with nutrition. It has been used 
with good results in acne of the face, and is stated to be of 
service in both promoting and relieving strangury from can- 
tharides. Potash, however, is liable to cause gastric irritation, 
and hence to obtain the effects of alkalies upon internal organs 



POTASSIUM. 159 

potassium, bicarbonate, citrate and acetate are usually employed 
in preference to it. 

TOXICOLOGY. 
See Sodium Hydroxide. 

2. POTASSII CARBON AS.— Potassium Carbonate. (Salt of Tar- 
tar.) Dose, 1 gm.; 15 gr. 

3. POTASSII BICARBONAS.— Potassium Bicarbonate. Dose, 2 
gm.; 30 gr. 

Action of Potassium Carbonate. 
The action of potassium carbonate is essentially the same as 
that of potassium hydroxide, except that it is much less corro- 
sive. In solution it rarely induces actual lesions of the skin 
unless after very prolonged application. 

Therapeutics of Potassium Carbonate. 
In weak solution or as a paste it is sometimes used externally 
for the relief of itching in cutaneous diseases. It is also em- 
ployed in baths, where its irritant action on the skin is made 
use of to soften the epidermis and cause stimulation of extensive 
areas, as is often desirable in such affections as ichthyosis. 
For internal use potassium bicarbonate is almost invariably 
preferred, as the carbonates are too irritating to the stomach. 
It enters into the composition of the Pilulae Ferri Carbonatis. 

Action of Potassium Bicarbonate. 
The hydrates are much more powerful solvents than the car- 
bonates, and these than the bicarbonates. Hence potassium 
bicarbonate is but very feebly caustic. Otherwise its pharma- 
cological action is the same as that of the carbonate. 

Therapeutics of Potassium Bicarbonate. 

Stomach. — While it is always advisable to remove the cause, 

if possible, the alkalies often serve a very useful purpose in the 

treatment of dyspepsia. Sodium bicarbonate is much more 

generally relied upon to give relief, particularly in cases of 



l6o PHARMACOLOGY AND THERAPEUTICS. 

hyperacidity, than potassium bicarbonate. Where no excessive 
acidity exists, however, the latter is often preferred, and is 
commonly efficacious in relieving the distention and discomfort. 
It should be given in small doses and well diluted, so that it 
may not irritate the stomach. Alkalies are of great service 
when there is impaired digestion of fats, not only preventing 
the formation of butyric acid, but also assisting the emulsi- 
fication and absorption of the fats. In affections of the liver, 
and when from any cause the flow of bile into the intestine is 
interfered with, they are likewise useful in promoting the di- 
gestion and absorption of fats. In these conditions potassium 
bicarbonate is considered preferable to other alkaline remedies. 
Potash water may be used as a substitute for soda water. It 
is made by passing carbon dioxide gas, under a pressure of 
four atmospheres, into an aqueous solution of potassium bi- 
carbonate of the strength of half of one per cent. Potassium 
bicarbonate should not be employed as an alkali in cases of 
poisoning by mineral acids, on account of the evolution of 
carbon dioxide gas which is likely to result. 

Blood. — The absorption of both hydrates and carbonates leads 
to an increase in the alkalinity of the blood and tissues. Po- 
tassium bicarbonate and other alkalies have been used very 
extensively in the treatment of gout, rheumatism and the so- 
called uric acid diathesis generally. The explanation offered 
of their action in these conditions was that the increased oxi- 
dation caused by them results in the destruction of a larger 
amount of the uric acid, while, in addition, the latter, being 
neutralized in the tissues, is excreted more easily and has less 
tendency to be deposited. In the light of our present knowledge 
neither of these theories appears to be tenable. At the same 
time, there is abundant clinical evidence that the alkalies are 
of some value in gout and rheumatism, although in the treatment 
of the latter disease they have to a large extent fallen into dis- 
use since the introduction of the salicylates. It must be con- 
fessed, therefore, that their mode of action is not clearly under- 
stood, though there is some ground for the belief that these 



POTASSIUM. l6l 

agents may influence the formation, rather than the excretion, 
of uric acid. In acute rheumatism it has been shown that any 
influence exerted by the alkaline treatment in cutting short the 
disease, lowering temperature, and relieving pain, is in no 
way comparable to that of the salicylates, which as has been 
mentioned, have now to a great degree superseded alkalies in 
• the treatment of that affection. The opinion is still held by 
many experienced observers, however, that alkalies have a 
decided effect in preventing and relieving cardiac complications, 
and thus succeed, to some extent, it is claimed, where the sali- 
cylates fail. Hence it is the practice of some to associate the 
latter with alkalies. In acute rheumatism potassium bicarbon- 
ate may be given in doses of 1.20 to 2.40 gm. (20 to 40 gr.) 
every two to four hours, or 15 gm. (y 2 oz.), or more, may be 
dissolved in barley water, and administered as a drink during 
the twenty-four hours. As the remedy is very distasteful to 
most persons, it may be given in effervescence with lemon- juice, 
or with citric acid solution. An equal quantity of potassium 
citrate is sometimes prescribed with the carbonate when given 
in this way. It has been found that the alkaline treatment, 
however well adapted it may be to plethoric and muscular 
individuals, is not usually suited to the delicate and anaemic. 

Other Uses. — Potassium bicarbonate is not infrequently used 
with benefit in jaundice and gall-stone. It probably has no 
direct effect on the bile, except perhaps in increasing its liquid- 
ity, but affords relief principally by lessening duodenal irrita- 
tion. In bronchitis, added to other expectorants, it serves to 
increase the secretion and render it less viscid and tenacious. 

4. POTASSII ACETAS.— Potassium Acetate. Dose, 2 gm.; 30 gr. 

5. POTASSII CITRAS.— Potassium Citrate. Dose, 1 gm.; 15 gr. 

Preparation. 
Liquor Potassii Citratis. — Solution of Potassium Citrate. 
Dose, 16 c.c; 4 fl. dr. 

6. POTASSII CITRAS EFFERVESCENS.— Effervescent Potas- 
sium Citrate. Dose, 4 gm.; 60 gr. 

12 



1 62 PHARMACOLOGY AND THERAPEUTICS. 

Acton of Potassium Citrate and Acetate. 

External. — Potassium citrate is a salt of neutral or very 
slightly acid reaction. The acetate is perfectly neutral, and 
neither of them has any external action. 

Internal. — They are the least irritating to the stomach of 
all the potassium salts, and, with the exception of the tartrates, 
the citrate is the least offensive to the palate. They have the 
advantage of not neutralizing the gastric juice, or in any way 
affecting the digestion except from their salt-action, which' 
may be minimized by administration in dilute solution. Being 
decomposed in the body, with the formation of carbonates, 
they exert an alkaline action after absorption, and this has 
the effect of increasing the alkalinity of the blood and of the 
urine, and of producing free diuresis. On account of its influ- 
ence on the urinary secretion the acetate was formerly known 
as sal diureticus. The citrate is not so readily absorbed as the 
acetate, and therefore tends to act on the bowels. It is not 
cathartic, however, except when given in large quantities. 
They both have some diaphoretic action, which is rather more 
marked in the case of the citrate. Potassium acetate, like 
other acetates, is technically a food, as its oxidation supplies 
energy to the body. Since the acetates, however do not lessen 
the nitrogenous tissue-change, they are incapable of replacing 
the fats and carbohydrates, and as they derange the stomach 
in the same way as common salt and also alter the character 
and amount of the urine, they are found to be practically 
useless as foods. 

Therapeutics of Potassium Citrate and Acetate. 
Blood. — Both these salts are largely -employed in gouty con- 
ditions, and were formerly much used also in the alkaline 
treatment of acute rheumatism. The citrate dissolved in an 
excess of lemon juice affords the most agreeable method of 
securing the influence of an alkaline potassium salt upon the 
system. They have some antiscorbutic effect, but are not so 
efficient in the prevention and treatment of scurvy as lemon- 
juice, lime-juice, and fresh vegetables. 



POTASSIUM. 163 

Kidneys. — They are constantly used for their diuretic effect 
in feverishness, scarlatinal dropsy, chronic renal disease, gen- 
eral dropsy from valvular disease of the heart, and other con- 
ditions. Alkaline diuretics are of very little value, however, in 
dropsical accumulations in the various cavities, The best effects 
are usually obtained from a combination of diuretic remedies, 
and the following mixture will be found serviceable : Potassium 
acetate, 1.20 gm. (20 gr.) ; tincture of squill, .60 c.c. (10 HI) ; 
'spirit of nitrous ether, 2.00 c.c. (30 HI) ; juice of broom, 4.00 
c.c. (1 fl. dr.) ; water, to 30.00 c.c. (1 fl. oz.). Juice of broom, 
B. P., is obtained by bruising fresh broom tops, expressing the 
juice, adding one-third part of alcohol, and filtering after seven 
days. In irritation of the urinary organs resulting from an 
excess of acid and in inflammatory conditions of the passages, 
in which the acid urine acts as an irritant, they are of great 
service by rendering the urine alkaline, and they possess the 
advantage over other potassium salts of not affecting the 
stomach or interfering with digestion. In such conditions the 
Liquor Potassii Citratis is highly esteemed. It was long the 
opinion, and is still held by many, that the continued use of 
these salts will effect the solution of renal calculi, which are 
usually composed principally of uric acid. It has been shown, 
however, that the alkaline treatment is incapable of removing 
calculus either in the bladder or kidney. While outside the 
body free alkalies and their carbonates dissolve uric acid quite 
readily, it is found that the solution of the alkalies formed in 
the urine is extremely dilute, the reaction, except under large 
doses, being in fact not even constantly neutral. On the other 
hand, it is pointed out, even the alkaline urates are by no means 
very soluble bodies, and are formed only with difficulty except 
in strong alkaline solutions. Some authorities contend that the 
alkalies, not being excreted as such, nor as carbonates, can- 
not convert free uric acid into soluble alkaline urates, but at 
most into acid urates, which are almost as insoluble as uric 
acid itself. Hence, it would be absolutely impossible to effect 
in this wav the solution of even verv small calculi. The fact 



164 PHARMACOLOGY AND THERAPEUTICS. 

that in certain instances alkaline treatment has been observed 
to cause the breaking up of large stones into small fragments 
is explained on the hypothesis that the calculi were composed 
originally of small fragments glued together by mucus, and 
that the alkali caused the solution of the latter. Furthermore, 
it is claimed that the alkalies are to some extent objectionable 
in vesical calculus, inasmuch as alkaline urine is liable to de- 
posit phosphates in the bladder, and thus rather to increase the 
size of the stone than to diminish it. Still, there can be no 
question that in any of the forms of irritation of the urinary 
passages (from gravel, stone, cystitis, stricture, enlarged pros- 
tate, etc.), such agents as potassium citrate and acetate afford 
great relief whenever the urine is acid in reaction. There is 
also high authority for the opinion that they are of utility in 
the prevention of uric acid gravel, it. being held that the most 
potent factor in determining the precipitation of free crystal- 
line uric acid in the urinary passages is a high degree of 
acidity in the urine; so that if the latter be rendered alkaline, 
or only faintly acid, no such precipitation can occur. In the 
daytime the alkaline tide following the ingestion of meals will 
usually keep the urine from attaining an acidity sufficient for 
the precipitation to occur, but during the fasting hours of the 
night the opportunity for this is afforded. Hence, it is ad- 
vised that a moderately large dose of an alkali, such as 2.50 
to 4.00 gm. (40 to 60 gr.) of potassium citrate should be taken at 
bedtime. In case this is not sufficient to prevent the hyper- 
acidity during all the hours of sleep, a second dose should be 
taken in the course of the night, while in exceptional instances 
the tendency to uric acid precipitation may be so great as to 
require the use of the remedy in the daytime also. This pre- 
ventive treatment, it can readily be seen, may be materially 
aided by a judicious arrangement of the meals, so as to avoid 
unnecessarily prolonged periods of fasting. 

Skin. — In feverish conditions, such as frequently result from 
an ordinary cold, they are of service on account of their diapho- 
retic as well as their diuretic action. 



POTASSIUM. 165 

Respiratory Passages. — Like potassium bicarbonate, they are 
of considerable utility in bronchitis, assisting the action of 
other expectorants by increasing the secretion and by render- 
ing it more fluid and more easily expectorated. 

7. POTASSII SULPHAS.— Potassium Sulphate. Dose, 2 gm.; 30 
gr. 

8. POTASSII BITARTItAS.— Potassium Bitartrate. (Acid Potas- 
sium Tartrate. Cream of Tartar.) Dose (diuretic), 2 gm.; 30 gr. 

Action of Potassium Bitartrate and Sulphate. 

External. — The aqueous solution of potassium bitartrate has 
an acid reaction on litmus paper, but it is only slightly acid, 
while the sulphate is neutral. Neither has any external action. 

Internal. Intestines. — They are hydragogue saline cathartics, 
drawing fluid from the blood and tissues into the intestine, and 
consequently rendering the blood more concentrated than usual. 
This leads to a sensation of thirst and to a lessened excretion 
of fluid by the kidneys and other glands. They produce rather 
profuse watery stools, with practically no irritation or griping. 
To the sulphate, however, the last statement applies only when 
it is given in comparatively small doses (.60 to 2.40 gm. ; 10 to 
40 gr.) and freely diluted. In large doses and when insuffi- 
ciently diluted it is a powerful irritant, and from 45 to 60 gm. 
(13^2 to 2 oz.) has been known to cause fatal gastro-enteritis, 
while 15 gm. (4 dr.), if not properly diluted, may give rise to 
grave symptoms. In France it is stated to be used as a popu- 
lar abortifacient ; the ecbolic effect being secondary to the in- 
flammation produced in the alimentary canal. 

Liver. — Potassium sulphate has been supposed to have some 
action in increasing the biliary secretion, but, as in the case of 
other saline purgatives regarded as cholagogues, this has now 
been shown to be incorrect. 

Kidneys. — The bitartrate, which is but slowly absorbed, is to 
a large extent excreted unchanged in the urine and faeces. 
That portion which is absorbed is converted into carbonate, 
which has a decided diuretic effect and also tends to render the 



1 66 PHARMACOLOGY AND THERAPEUTICS. 

urine alkaline. All the Sulphate is believed to be excreted un- 
changed; consequently, it has no remote effects. 

Therapeutics of Potassium Sulphate and Bitartrate. 

G astro-Intestinal Tract. — Potassium sulphate, while used to 
some extent in Europe, is rarely ever prescribed in this coun- 
try; magnesium and sodium sulphates being much preferred 
to it. The bitartrate is frequently employed as a cooling 
aperient, and for this purpose a dose of it (2 to 8 gm. ; y 2 to 
'2 dr.) may be dissolved in a glass of hot water, and sipped 
during dressing in the morning. Its use should not be con- 
tinued regularly too long, however, as it is liable to impair 
nutrition. In doses of 15 to 30 gm. (y 2 to 1 oz.) it is a valuable 
hydragogue cathartic, particularly in dropsy and uraemia. It 
is often combined with senna, magnesia or sulphur, or with 
jalap, as in compound jalap powder. With sulphur or with 
confection of senna it constitutes a convenient laxative when 
haemorrhoids are present. With magnesia it is sometimes pre- 
scribed in habitual vomiting arising from gastric acidity and 
also in the vomiting of pregnancy. 

Kidneys. — The bitartrate is highly esteemed as a diuretic, 
and 30 gm. (1 oz.) in 500 c.c. (1 pint) of infusion of juniper- 
berries, taken in divided doses during the twenty-four hours, 
is often very serviceable in dropsy. This is too irritating to 
the kidneys, however, to be used in acute desquamative nephritis. 
Cream of tartar whey is made by dissolving about 8 gm. (2 dr.) 
of the bitartrate in 500 c.c. (1 pint) of milk. The beverage 
known as "imperial" (potus imperialis) may be used with ad- 
vantage in some febrile affections. It consists of potassium 
bitartrate, 4 gm. (1 dr.); saccharin, .06 gm. (1 gr.) ; oil of 
lemon, .20 c.c. (3 Ttl) ; to 500 c.c. (1 pint) boiling water. The 
bitartrate is also conveniently given in ordinary lemonade, the 
salt being dissolved in hot water and the solution allowed to 
cool before the lemons are added to it. Compound jalap powder 
is rendered more efficient, both as a diuretic and a purgative 
by the addition of .60 gm. (10 gr.) of potassium bitartrate to 
each dose. 



POTASSIUM. 167 

Liver. — In hepatic cirrhosis,, whether due to alcoholism or 
other causes, as well as in chronic peritonitis, good results are 
said to be sometimes obtained from potassium bitartrate. Both 
the bitartrate and the sulphate have been used in gall-stone 
disease. 

9. POTASSII NITRAS.— Potassium Nitrate. (Xitre. Saltpetre.) 
Dose, 0.500 gm. (500 milligm.) ; 7 l / 2 gr. 

Action of Potassium Nitrate. 

External. — It has no action on the unabraded skin, but is 
irritant to mucous membranes and raw surfaces. 

Internal. — Gastro-Intestinal Tract. — In small doses it is un- 
irritating. In large quantities it is a decided gastro-intestinal 
irritant, producing nausea, vomiting, intense burning pain in 
the stomach, and sometimes purging. In some instances blood 
is present in the matters vomited and in the stools. After death 
there is found congestion of the stomach and intestines, and 
there may be extravasations of blood. Even ulceration and cor- 
rosion of the mucous membrane have been observed. When 
it is very freely diluted, however, the local irritant action of 
the drug is in great measure prevented, and very considerable 
quantities may be taken without serious results. 

Blood. — External to the body, nitrates have the effect of 
preventing the coagulation of the blood and of dissolving 
clots already formed. In the body they are said to have some 
influence on the red blood-corpuscles, which become crenated; 
but it is thought that this is probably merely the salt-action, 
and not any specific nitrate effect. By reason of its high 
diffusion power potassium nitrate rapidly passes into the blood 
unchanged. 

Heart. — It is so violently irritant that the local symptoms 
produced by toxic quantities are apt to overshadow the effects 
on the system of its potassium ion. The latter, however, is 
depressant to the heart, weakening its movements and finally 
arresting them. 

Nervous System and Muscles. — Sometimes the nervous symp- 



1 68 PHARMACOLOGY AND THERAPEUTICS. 

toms predominate, and the collapse caused by the drug may 
be accompanied with paralysis of the lower extremities. It 
tends to exert a paralyzing- influence upon the spinal cord, 
and produces great muscular weakness and reduction of reflex 
sensibility. It also tends to paralyze unstriped muscular fibre. 

Respiration. — Large doses retard the respiration. 

Skin. — It has a slight diaphoretic effect. 

Kidneys. — In moderate amounts it has considerable diuretic 
influence, which is believed to be due in part to the salt-action 
and partly to a true stimulation of the kidney, such as is ex- 
erted by many other intestinal irritants. Large quantities 
tend to produce renal inflammation and hematuria, and in some 
cases of poisoning the kidney is recorded to have presented 
the lesions of acute nephritis, and also haemorrhages. 

Elimination. — Some of the nitrate given by the mouth is 
usually found unchanged in the urine, but the greater portion 
disappears in the tissues. Its fate in the body is not certainly 
known, but it is supposed that it is reduced first to the nitrite, 
and then to ammonia, or that it is eventually excreted by the 
lungs as free nitrogen. Some of the nitrate is apparently 
excreted in the saliva and perspiration; it may be unchanged, 
although it is said to be rapidly reduced to nitrite in these 
secretions, and may in fact be changed to this form in the 
secretory cells. 

Therapeutics of Potassium Nitrate. 
It was formerly used to a large extent in febrile diseases, 
and especially acute rheumatism. At the present time, however, 
its internal administration for any purpose has been in great 
measure abandoned. It is stated, however, to be sometimes of 
value in the treatment of haemorrhage, more particularly haemop- 
tysis accompanied with febrile movement, and to have been 
given with advantage in purpura simplex (in 60 gm. ; 10 gr. 
doses) and purpura haemorrhagica (in doses of from .60 to 4 
gm. ; 10 to 60 gr.). As a diuretic it has been almost entirely 
superseded by the citrate and acetate, but is still used by some 



POTASSIUM. 169 

as an ingredient of diuretic mixtures, with digitalis and other 
drugs. When given internally it is recommended that it should 
be carbonated in order that its absorption may be accelerated 
and the gastric irritation proportionately lessened. A small 
amount (.12 gm. ; 2 gr.) in a glass of sweetened water will, 
it is said, relieve the hoarseness to which speakers and singers 
are liable. By reason of its influence on the respiration and 
on unstriped muscular fibre, potassium nitrate acts as an anti- 
spasmodic, and the one great purpose for which it is now em- 
ployed is the relief of the symptom asthma. For the treat- 
ment of this, linen or blotting paper, dipped in a saturated 
solution of nitre and then dried, is burned, and the patient 
inhales the fumes. It is advised by some that the paper should 
be also dipped in a solution of potassium chlorate. The fumes 
may be diffused generally in the room, or if a more concentrated 
effect is desired the paper may be burned under a funnel, from 
the mouth of which the patient inspires. The nitrate is a com- 
mon ingredient of so-called asthma powders, and is also some- 
times used in the form of cigarettes. Powdered nitre, moistened 
with water and applied to the face night and morning, is useful 
for removing freckles. 

10. POTASSII CHLORAS.— Potassium Chlorate. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

Preparation. 
Trochisci Potassii Chloratis. — Troches of Potassium Chlorate. 

Action of Potassium Chlorate. 

External. — Locally it is disinfectant and stimulant to mucous 
membranes. It is easily decomposed by septic tissues, and the 
nascent oxygen given off acts as a stimulant and antiseptic to 
them. 

Internal. Stomach and Intestines. — Small doses have no 
effect. Sometimes the only effect in the alimentary canal of 
large doses is to cause some nausea and vomiting. In other 
instances the irritation caused by it is sufficient to excite gastro- 
enteritis. The first symptom is often prolonged and violent 



170 PHARMACOLOGY AND THERAPEUTICS. 

vomiting. There is severe gastric pain, and this may be fol- 
lowed by profuse diarrhoea. In subacute poisoning vomiting 
and diarrhoea are also observed, and the matter vomited usually 
contains bile, and sometimes blood. The nausea and vomiting 
are believed to be principally due to the local salt-action of the 
drug, but that this is not their only cause seems to be shown 
by the fact that vomiting has been observed in animals in 
which the chlorate was injected subcutaneously. After death 
swelling and ecchymosis of the mucous membrane of the 
stomach and intestines have been found. 

Blood. — When added to blood, either outside or in the body, 
it causes the formation of methaemoglobin from the conversion 
of haemoglobin ; so that its administration in toxic quantity may 
produce an actual asphyxia. It also has the effect of subse- 
quently causing the destruction of the red blood-cells, with re- 
sulting liberation of proteids. In the most acute form of in- 
toxication death is due chiefly to asphyxia caused by the 
reduction of a large amount of haemoglobin, but if the quantity 
of methaemoglobin thus formed is smaller, it is found that the 
latter gradually disappears. Hence, in the subacute form of 
poisoning sufficient haemoglobin remains untransformed to con- 
tinue the respiration of the tissues. When cases of this kind 
terminate fatally some of the red corpuscles are found altered 
in shape, others are colorless, and in some the pigment, in- 
stead of being generally diffused, is aggregated in masses. No 
methaemoglobin may be discovered, but the debris of the cor- 
puscles can be found in the liver, spleen, bone-marrow and 
renal tubules. In acute poisoning the color of the blood is very 
dark and the methaemoglobin absorption band is found present 
in the spectrum. 

Heart and other Organs. — Toxic doses are likely to cause 
great failure of the heart's action, excessive dyspnoea, and 
marked cyanosis of the surface. Increase in the amount of 
bile pigment results from the excessive destruction of red blood- 
corpuscles, and the absorption of the pigment from the bile 
capillaries may cause jaundice. After death both the liver and 



POTASSIUM. I/I 

spleen have been found enlarged, from the deposition of the 
debris in them. 

Nervous System. — Among the nervous symptoms noted are 
headache, delirium, tonic and clonic spasms, coma, and a 
peculiar stiffness of the extremities. These are believed to be 
due, not to any specific effect upon the central nervous system, 
apart from the salt-action of the chlorates, but to the blood 
changes caused by the drug and to the uraemia resulting from 
its effects in the kidneys. The course of the poisoning may be 
very rapid, death having been known to be caused in two and 
a half hours; but usually it does not occur for several days. 
The fatal result may be due either to asphyxia, to collapse from 
cardiac weakness, or to uraemia. Death from uraemic symptoms 
may follow as late as a week after the appearance of the first 
signs of poisoning, while in several instances complete re- 
covery has occurred where the most severe effects had been 
caused. A rare effect of potassium chlorate is the production 
on the skin of an erythematous, vesicular or papular eruption. 

Kidneys. — The effects of potassium chlorate in the kidneys 
are of great interest. In the subacute form of poisoning the 
products of the destruction of the red blood-corpuscles are ex- 
creted in the urine, and in consequence the renal tubules be- 
come stopped up with brown granular masses. These are found 
to be in part forced downwards and to appear in the urine as 
casts, but may produce an almost complete suppression of urine 
and the consequent symptoms of uraemia. Probably as the re- 
sult of the plugging of the tubules, the epithelial cells may per- 
haps become inflamed, but often, it is stated, no actual nephritis 
is present. The opinion formerly held that the chlorate be- 
comes reduced and yields its oxygen in the system has been 
shown to be entirely incorrect. It passes unchanged through 
the body, being principally excreted in the urine, from which 
90 to 96 per cent, of the amount given by the mouth has been 
recovered. It is also excreted in small quantities in the per- 
spiration, saliva, tears, and probably all the other secretions, 
and is stated to pass from the mother to the foetus in utero. 



172 PHARMACOLOGY AND THERAPEUTICS. 

While the secondary effect of potassium chlorate may tend to 
produce suppression of the urine, through the results in the 
kidneys of its destructive influence on the red blood cells, the 
absorption of concentrated solutions is often shortly followed 
by considerable diuresis, from an action upon the kidney similar 
to the local salt-action in the stomach which induces nausea 
and vomiting. 

Therapeutics of Potassium Chlorate. 
In the case of no drug has a greater change of opinion taken 
place than as regards potassium chlorate. Under the supposi- 
tion that it yielded its oxygen to the blood it was for many 
years extensively used in adynamic fevers and in diphtheria 
and other diseases attributed to blood-poisoning. Its internal 
use, however, is now regarded as of little value, and may cause 
toxic symptoms ; but locally it has distinctly curative effects 
upon mucous membrane in such conditions as catarrhal in- 
flammation of the mouth and fauces, aphthous, ulcerative and 
mercurial stomatitis, and thrush, or nursing sore-mouth, as 
well as in acute tonsilitis. Its local action is not clearly under- 
stood. It has been suggested that it is an oxidizing disinfectant, 
but there appears to be no ground for supposing that it is 
changed here any more than in the tissues in general. It may 
be applied in the form of a wash or gargle, and is sometimes 
associated with other agents. In young children solutions of 
it are used with glycerin, honey or syrup to wash out the mouth. 
Of course, it is essential to the success of the treatment that 
the general condition of the patient should also be carefully 
looked after. It is sometimes given internally in solution, or 
in the form of lozenges, with the idea of obtaining its local 
effect while being swallowed and a subsequent similar effect 
from its excretion in the saliva. If it has no beneficial systemic 
action it would seem preferable to depend entirely on its local 
application, which can be repeated as often as the circumstances 
require, and thus avoid the possibility of poisoning the patient. 
On account of this danger the use of potassium chlorate lozenges 
is condemned by some authorities. If the salt is employed 



POTASSIUM. 173 

internally it should always be administered with great caution, 
and pains should be taken to avoid giving it on an empty 
stomach. In diphtheria it has been thought especially effective 
in combination with tincture of ferric chloride and hydrochloric 
acid, in which, in addition to the local influence of the chlorate 
and the tonic effect of the iron, the action of free chlorine, gen- 
erated in the mixture, is obtained. It should not be exhibited 
in full doses, however, on account of the depressing effects 
upon the heart, as well as the danger of renal trouble. A tea- 
spoonful of the following may be given undiluted every two 
hours: To 4 gm. (1 dr.) of powdered potassium chlorate, mixed 
with 6 c.c. (iy 2 fl. dr.) of hydrochloric acid, are added 8 c.c. 
(2 fl. dr.) of tincture of ferric chloride and enough water to 
make 120 c.c. (4 fl. oz.). In order to render it less disagreeable 
to the taste a considerable proportion of the water may be sub- 
stituted by glycerin or a syrup such as that of blood orange. 
Diluted, this mixture makes an excellent gargle. Solutions 
of potassium chlorate which may be combined with a few drops 
of laudanum to secure retention, injected into the rectum at 
bed-time, are said to be of great service in haemorrhoids, and 
large enemata composed of them are sometimes employed in 
chronic dysentery and other diseases of the lower bowel. A 
solution in glycerin (one part to ten) has been highly com- 
mended as a dressing for ill-conditioned wounds and ulcers. 

TOXICOLOGY. 
As potassium chlorate is very largely used as a domestic remedy and 
is not regarded by the laity as a toxic agent, accidental poisoning from 
it is not unlikely to occur. The injurious effects of the drug have al- 
ready been sufficiently described. In the treatment the stomach should 
be promptly evacuated if there is reason to suppose that any of the salt 
still remains in it. Demulcents such as white of egg, milk, flaxseed tea, 
or mucilage of acacia may be used, and ice given to control the vomit- 
ing. Each case should be treated according to the special symptoms 
met with. Cardiac stimulants or stimulants to the central nervous sys- 
tem may be called for. As the destructive action of the chlorate upon 
the blood is believed to be less liable to occur when the latter is more 



174 PHARMACOLOGY AND THERAPEUTICS. 

alkaline than usual, the alkaline carbonates should generally be given in 
the hope of preventing or checking these effects. After the acute symp- 
toms have passed off the administration of diuretics and large quantities 
of fluid is recommended for the purpose of washing out the kidneys and 
preventing the accumulation of detritus in the tubules. 

SODIUM. 

1. SODII HYDROXIDUM (Soda, U. S. P., 1890).— Sodium Hy- 
droxide. (Caustic Soda. Sodium Hydrate.) 

Preparation. 
Liquor Sodii Hydroxidi (Liquor Sodae, U. S. P., 1890). — 
Solution of Sodium Hydroxide. (Solution of Soda.) Dose, 1 
C.C.; 15 TTt. 

Action of Sodium Hydroxide. 
Its action is practically the same as that of potash. The 
principal difference between the effects of the sodium and 
potassium salts, when given in large amount, is the depressant 
influence of the latter upon the cardiac, muscular and nervous 
systems. It must be borne in mind, however, that soda and 
the sodium carbonates, like the potassium hydrate and carbon- 
ates, depend chiefly for their activity on their alkalinity, and not 
on their metallic constituent. It is their hydroxyl ion which 
induces the alkaline reaction of the solutions and determines 
their physiological effects. 

Therapeutics of Sodium Hydroxide. 
It is very little used. Potash is almost always preferred. 

TOXICOLOGY. 

Poisoning by caustic alkalies is not very commonly met with. In 
addition to potash and soda, it may be caused by the impure potassium 
carbonate (pearlash) or sodium carbonate (soap lees), which contain 
these alkalies. The carbonates, however, are much less corrosive than 
the hydrates. 

Symptoms. — The symptoms are those of a violent corrosive poison: 
burning heat in the throat and stomach, intense thirst, salivation, vom- 
iting of blood-stained matter, agonizing abdominal pain accompanied 



SODIUM. 175 

with diarrhoea, feeble pulse, cold, clammy skin, and general collapse. 
The lips, mouth, tongue and throat become swollen and assume a bright 
red color. The larynx is apt to be involved in the corrosive action, and 
oedema of the larynx may cause death in a very brief time. If the 
patient should survive the immediate effects of the poison he is very 
likely to suffer from more or less extensive ulceration or cicatrization 
of the mucous membrane of the throat, oesophagus or stomach, which 
may subsequently prove fatal. In very exceptional instances the local 
action may be comparatively slight, and the principal effect of the poison 
expend itself upon the nervous system, with the result of producing 
muscular weakness, paralysis of the lower extremities, weak cardiac 
action, and coma : and, as has been stated, very large doses cause death 
suddenly, through paralysis of the heart, before the local inflammation 
has had time to develop. 

Post-mortem Appearances.* — The mucous membrane, wherever the 
caustic has come in contact with it, is dark-colored, inflamed and cov- 
ered with a grayish membrane. The sloughs may be very extensive and 
deep, and there may even be complete destruction of a portion of the 
stomach wall. In the event of the patient's having survived long enough 
for such sequel to occur, there will naturally be found evidences of peri- 
tonitis resulting from this lesion. In the oesophagus the points espe- 
cially affected will generally be found at its two ends and at the place 
where it crosses the left bronchus, and in the stomach, at the pylorus. 

Treatment. — The stomach should be evacuated as promptly as pos- 
sible, but it is not safe to use the stomach-pump for this purpose, as 
the tube is liable to perforate the corroded wall of the oesophagus or 
stomach. Any one of the following emetics may be resorted to : Apo- 
morphine hydrochloride, .006 gm. ( T L gr.), by subcutaneous injection; 
zinc sulphate, 1.20 gm. (20 gr.), or copper sulphate, .30 gm. (5 gr.), 
in 250 c.c. {y 2 pint) of tepid water; powdered ipecacuanha, 2.00 gm. 
(30 gr.) or wine or syrup of ipecacuanha, 30 c.c. (1 fl. oz.). The prep- 
arations of ipecacuanha should not be employed if other emetics are 
available, as this drug, which produces vomiting chiefly by its influence 
on the medulla oblongata, is not sufficiently prompt in its action. If 
none of these agents is quickly attainable, domestic remedies such as 
mustard, 16 gm. (1 tablespoonful) or common salt, 30 gm. (2 table- 
spoonfuls), may be administered in 250 c.c. (y 2 pint) of tepid water. 
At all events, plenty of lukewarm water should be given, and vomiting 
promoted by tickling the fauces. As soon as the stomach has been 
emptied some form of dilute acid should be employed. The organic 
acids — acetic, citric or tartaric — are the best, and vinegar is almost 



I76 PHARMACOLOGY AND THERAPEUTICS. 

always within easy reach. In place of it, lemon juice, acetic acid, or 
solution of citric acid (all of which should be well diluted with water) 
may be used. Demulcents such as white of egg, olive oil, or flaxseed 
tea are of service, and measures to counteract shock, heart-failure, and 
collapse, such as the application of warmth, the exhibition of stimulants, 
etc., are also generally called for. 

2. SODII CARBONAS MONOHYDRAS.— Monohydrated Sodium 
Carbonate. Dose, 0.250 gm. (250 milligm.) ; 1 gr. 

Unofficial Preparation. 
Sodii Carbonas Exsiccatus (U. S. P., 1890).— Dried Sodium 
Carbonate. Dose, .30 to 1.00 gm.; 5 to 15 gr. 

Action of Sodium Carbonate and the Dried Carbonate. 
As in the case of potassium, the carbonate is much less cor- 
rosive than the hydrate. With this exception, the action is 
the same as that of soda. Sodium carbonate is, however, 
decidedly more irritating than the bicarbonate. 

Therapeutics of Sodium Carbonate and the Dried Car- 
bonate. 
A one per cent, solution of sodium carbonate is used for 
boiling surgical instruments in the process of sterilization, in 
order to prevent their rusting. The carbonate is also employed 
externally to some extent in the treatment of skin diseases in 
which the eruption is of a dry character, as lichen, prurigo, 
ichthyosis, psoriasis and pityriasis, and especially in the form 
of baths. From 125 to 450 gm. (4 to 16 oz.) is dissolved in a 
sufficient quantity of tepid water, and it is advised that each 
bath should be at least an hour in duration. It has the effect 
of stimulating the affected portions of the skin, and at the 
same time of removing sebaceous and acid secretions. If, how- 
ever, there is already an irritable condition present, but a 
small quantity of the alkali should be used, and mucilage or 
bran may be added to the water to render the bath more 
bland. This treatment is generally unsuitable for vesicular 
and pustular eruptions, but may occasionally prove of service 



SODIUM. 177 

iii them if the solution is made very weak. Lotions containing 
sodium carbonate have been used in certain local eruptions, 
especially those of the scalp, and also in pruritus vulvae. The 
salt is rarely employed internally except as it occurs in alka- 
line mineral waters. As an antidote to acids in corrosive poison- 
ing, however, it is regarded as preferable to the bicarbonate, 
for the reason that less carbon dioxide is formed. 

3. SODII BICARBONAS.— Sodium Bicarbonate. (Baking Soda. 
Soda.) Dose, 1 gm.; 15 gr. 

Preparation. 
Trochisci Sodii Bicarbonatis. — Troches of Sodium Bicar- 
bonate. 

Action of Sodium Bicarbonate. 
As regards general alkaline properties the action of sodium bi- 
carbonate is the same as that of potassium bicarbonate, but it 
differs from it in being less rapidly absorbed from the alimentary 
canal. It is much more grateful to the stomach than either 
sodium or potassium carbonate. 

Therapeutics of Sodium Bicarbonate. 

External. — Either in saturated solution or as a fine powder 
sodium bicarbonate, locally applied, is the best remedy to relieve 
the pain from burns. Of late it has been strongly recommended 
to be used for packing to prevent pain after operations upon 
the vagina. To relieve itching a lotion of .50 gm. (7 gr.) to 
30 c.c. (1 fl. oz.) may be employed, and a saturated solution 
has been found an efficient cure in poisoning by Rhus toxi- 
codendron. Applied in powder to the tonsils in the initial 
stage of acute tonsilitis, it is claimed that it will often prevent 
the further development of the disease. 

Internal. — In dyspeptic conditions, and especially hyperacidity 

of the stomach, it is much more commonly used than any other 

alkali. Among the symptoms for the relief of which it may be 

employed are heartburn, sour eructations, aphthae, oesophageal 

13 



I78 PHARMACOLOGY AND THERAPEUTICS. 

spasm, cramp in the stomach, colic, and irregular diarrhoea. In 
cases of hyperacidity it is given after meals, often affording 
immediate relief, and, like other alkaline preparations, it should 
be always well diluted in order to avoid undue irritation. 
When the secretion does not seem to contain an excessive 
amount of acid it is sometimes prescribed before meals, and 
it may then be combined with other stomachics, such as bitters 
or volatile oils. Dilute solutions of the alkalies act as mild 
irritants to the stomach wall, and thus, it is thought, improve 
its circulation, and lessen pain, eructation and distention in 
the same way as other slight gastric irritants, such as the 
volatile oils, while in the case of the carbonates and bicarbonates 
this carminative action is strengthened by the carbon dioxide 
liberated by the hydrochloric acid. Furthermore, by their mild 
irritant action they increase mucus-secretion, and as they also 
have the effect of liquefying tenacious mucus, they serve to 
improve the condition of the stomach. If there is hyperacidity 
in the intestine, rather than the stomach, sodium bicarbonate is 
not suitable, because it is likely to be neutralized or absorbed 
before reaching the seat of trouble. In this case the insoluble 
alkaline earths or their carbonates should be advised. While 
the immediate result of potassium bicarbonate in hyperacidity 
of the stomach is highly beneficial, the after-effect is to in- 
crease the production of acid; so that those who habitually use 
the remedy for acid indigestion are extremely apt to suffer 
severely from acidity. It is very serviceable in the acid diar- 
rhoea of infants and young children, where it is often given 
combined with demulcents or with the aromatic syrup of rhu- 
barb. An important application of the salt is as an emetic in 
narcotic stupor when other emetics fail to act. From 2 to 4 
gm. (30 to 60 gr.) in solution in water is given to the patient 
(by means of the stomach tube if necessary), and this is fol- 
lowed by a similar quantity of tartaric acid. Brisk effervescence 
results, and the contents of the stomach are evacuated. The 
same expedient has been successfully tried in intussusception, in 
this case the two drugs being successively injected mto the 



SODIUM. 179 

rectum. Strong pressure being made on the anus to prevent 
its escape, the gas generated urges its way upward and forces 
the invaginated gut back to its normal position. A stomach or 
bowel much softened by inflammation or weakened by ulceration 
would constitute a contraindication to this practice. Brilliant 
results have been reported from the use of sodium bicarbonate 
and carbonate in the treatment of diabetic coma, when given 
early enough and in sufficient amount. If the alkali is used 
in the early stages before coma sets in, it is advised that it 
should be given in quantities of about 40 gm. (10 dr.) a day, 
while if coma has already supervened the amount should be 
100 or 200 gm. (25 or 50 dr.). If catharsis occurs after these 
large doses, so much of the alkali may escape by the bowels 
that it may be impossible to secure the absorption of a sufficient 
quantity. In this event it should be given by intravenous in- 
jection of 0.3 per cent, solution of the crystallized salt, as 
hypodermatic injection is apt to cause sloughing. It is insisted 
on that the administration of the remedy should not be left 
until coma actually occurs, as it may then be too late, and it 
is recommended that the treatment should be instituted as soon 
as the urine gives the characteristic reaction of acetone with 
ferric chloride. In digestive troubles sodium bicarbonate is 
often combined with gentian, and a common gastric sedative 
mixture consists of .60 gm. (10 gr.) each of sodium bicarbonate 
and bismuth subcarbonate, suspended in mucilage. A useful 
stomach powder for children is composed of .06 or .12 gm. 
(1 or 2 gr.) of the bicarbonate and .06 gm. (1 gr.) of pulver- 
ized rhubarb, with a little sugar. Effervescing soda water may 
be made from sodium bicarbonate in the same way as potash 
water from potassium carbonate (see p. 160). In commerce 
these waters contain neither potash or soda, but the carbon 
dioxide has some effect as a carminative. 

4. SODII SULPHAS.— Sodium Sulphate. (Glauber's Salt.) Dose, 
16 gm.; 240 gr. 

5. SODII PHOSPHAS.— Sodium Phosphate. Dose, 2 gm.; 30 gr. 



l8o PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Sodii Phosphas Effervescens.— Effervescent Sodium Phos- 
phate. Dose, 8 gm.; 120 gr. 

2. Sodii Phosphas Exsiccatus. — Exsiccated Sodium Phos- 
phate. Dose, 1 gm.; 15 gr. 

3. Liquor Sodii Phosphatis Compositus.— Compound Solution 
of Sodium Phosphate. Dose, 8 C.C.; 2 fl. dr. 

6. POTASSII ET SODII TARTRAS.— Potassium and Sodium Tar- 
trate. (Rochelle Salt.) Dose, 8 gm.; 120 gr. 

Preparation. 
Pulvis Effervescens Compositus. — Compound Effervescing 
Powder. (Seidlitz Powder.) Dose, one set of two powders. 

Action of Sodium Sulphate and Phosphate, and of 
Potassium and Sodium Tartrate. 

Internal. Intestines. — These are typical saline cathartics, 
differing from vegetable cathartics in not causing irritation of 
the intestine, except when given in very large quantities. They 
owe their action, not to irritation, but to retarded absorption, 
and their characteristic effect is due to their acid constituent. 
Saline cathartics cause the abstraction of fluid from the blood 
and its accumulation in the intestine. The quantity of liquid 
accumulated depends upon the nature and amount of the salt 
and the strength of the solution employed, and it has been found 
that the maximum amount corresponds closely to the quantity 
required to form a 5 or 6 per cent, solution of the salt em- 
ployed. The liquid withdrawn from the blood is quickly re- 
placed by liquid abstracted from the tissues, but there is a 
secondary concentration of the blood later, resulting from the 
subsequent diuresis occasioned by the portion of the salt ab- 
sorbed. After the maximum of accumulation in the intestine 
is reached, the fluid is gradually absorbed, and a soft painless 
motion generally occurs within two or three hours after the 
administration of the drug. The sulphate is the most active 
of these sodium salt cathartics, and it forms an important con- 



SODIUM. l8l 

stituent of many well-known mineral waters. It is the chief 
ingredient of Carlsbad, Marienbad, Franzensbad, Tarasp, Villa- 
cabras and Rubinat Condal waters, and occurs in association 
with magnesium sulphate in Friedrichshall, Hunyadi Janos, 
Apenta, Seidlitz, Kissingen, Pullna, yEsculap and Franz Joseph 
waters. Both the sulphate and phosphate are mild cholagogues, 
and Carlsbad waters have been shown to increase the amount, 
as well as the solid constituents, of bile. 

Blood and Kidneys. — On account of the slowness of their 
absorption they have less influence than the corresponding 
salts of potassium in rendering the blood and urine alkaline 
and in causing diuresis. It is said, however, that the basic 
portion of sodium sulphate is excreted much more quickly than 
the acid, so that the urine may be rendered alkaline temporarily. 
It is also stated that the intravenous injection of this salt pro- 
duces a copious diuresis. 

Therapeutics of Sodium Sulphate and Phosphate, and of 
Potassium and Sodium Tartrate. 
On account of its extremely nauseous taste, the sulphate is 
rarely used in this country, except as it occurs in the various 
aperient mineral waters. The taste may be in some degree dis- 
guised by the addition of a few drops of aromatic sulphuric 
acid, or by giving it in lemonade. In dysentery good results 
have been obtained from it in daily quantities of 10 gm. (2^ 
dr.). Its use as an antidote in carbolic acid poisoning, which 
was at one time recommended, on the supposition that it forms 
sulphocarbolates, which are not so poisonous, has been shown 
to be quite without effect on the progress of the intoxication. 
This, it is believed, is due to the fact that phenol does not 
combine with sulphates, as such, in the body, but with or- 
ganic sulphur compounds which are only in process of being 
oxidized to sulphuric acid. Rochelle salt is employed to a very 
considerable extent as a mild saline purgative. Although 
much less efficient, it is far less disagreeable to take than 
either magnesium or sodium sulphate, and is especially accept- 



l82 PHARMACOLOGY AND THERAPEUTICS. 

able in Seidlitz powders (Pulvis Effervescens Compositus), 
which form an effervescing draught. In small repeated doses 
it does not purge, and serves to render the urine alkaline. 
The phosphate is not so powerful a cathartic as the sulphate, 
but is also less offensive to the palate, and is used more or less 
in the case of children. Both these salts are often of service 
in gall-stones, probably chiefly by improving the condition of 
the mucous membrane of the intestine. The phosphate is 
useful in various affections of the liver, and is thought of 
especial value in cirrhosis, if commenced early and persistently 
administered. The belief has been expressed that it has the 
power to retard the development of the changes taking place 
in this disease, and, possibly, under favorable circumstances, 
to arrest them and to restore a comparatively normal functional 
state. By correcting a catarrhal condition of the duodenum 
its persevering employment is often efficacious in the prevention 
of biliary calculus. This salt is also useful in catarrhal jaun- 
dice. It is stated to have seemed very beneficial in the hepatic 
form of diabetes, and that it is of great service, especially when 
combined with sodium arsenate, in obese subjects when a suc- 
cession of boils portends the development of diabetes. When 
dissolved in a proper amount of water the following powder 
constitutes a good imitation of Hunyadi Janos, iEsculap, Franz 
Joseph and other natural waters: 2 gm. (30 gr.) each of sodium 
sulphate and magnesium sulphate, and .06 gm. (1 gr.) each of 
sodium chloride and sodium bicarbonate; dose, 4 to 15 gm. 
(1 to 4 dr.). The combination of 60 gm. (2 oz.) of sodium 
phosphate, 15 gm. (4 dr.) of sodium sulphate, and 2 
gm. (30 gr.) of potassium iodide, taken m sufficient 
laxative doses and well diluted upon risin'g, is said to be 
very efficient in such cases as are benefited by Carlsbad 
waters. All such remedies are more active when used hot. 
There can be no question of the value of the Carlsbad treat- 
ment in many cases of cholelithiasis, gouty dyspepsia, catarrh 
of the stomach and intestines, obesity, and other conditions, 
but it is highly probable that the benefit derived from it is 



SODIUM. I83 

largely due to the change in habits and the restricted diet pre- 
scribed, as well as to the medicinal virtue of the waters. In 
administering all saline cathartics it' should be borne in mind 
that they produce their proper effect only when given in solu- 
tions of a certain degree of dilution. Often it appears that 
just in proportion to the dilution of such a salt is its relative 
efficiency as a purgative, and this is well illustrated in the 
case of the natural mineral waters that have been referred to, 
which are purgative in quantities which contain only an incon- 
siderable proportion of the neutral salts. The phosphates 
have been supposed to be of benefit in nervous diseases, on 
the theory that these were due to the insufficiency of phosphorus 
in the brain, but there is high authority for the statement that 
the animal organism is unable to form combinations between 
phosphates and proteids. At the same time some neurological 
clinicians claim to have obtained good results from the use 
of sodium phosphate in a number of these affections. In 
tri-facial neuralgia, neurasthenia and hysteria it is stated that 
the results are often very satisf acton*. Subcutaneous injec- 
tions were employed of a mixture consisting of sodium phos- 
phate. 2 gm. (30 gr.), rectified spirit, 4 c.c. (1 fl. 5), and distilled 
water, 120 c.c. (4 fl. oz.). Of this 1 c.c. (15 1*1) were injected 
daily, and the amount gradually increased to 3 c.c. (45 ni). 
While believed to have only a palliative effect in organic dis- 
orders of nerve centers, this method is reported to have been 
attended with marked improvement in certain cases of loco- 
motor ataxia. 

7. SODII CHLORIDUM. — Sodium Chloride. (Common Salt.) 
Dose (emetic), 16 gm.; 240 gr. 

Actiox of Sodium Chloride. 
Sodium chloride, which is an important constituent of the 
animal economy, has practically no specific action. Its effects 
are limited to the alteration in the fluids produced by its excess 
or deficiency, and they present a typical example of what is 
known as salt action. As its molecular weight is small and 



I84 PHARMACOLOGY AND THERAPEUTICS. 

as it dissociates readily into its two ions, it possesses great 
osmotic power. This is made use of in the preservation of 
meats, which it effects by causing the withdrawal of their 
fluids and in this way rendering them hard and unfavorable 
for the development of microbes. Strong salt solutions, placed 
in contact with skin or mucous membrane, withdraw fluid 
from the surface cells, and this, together with the passage of 
salt into them, causes some irritation. They also withdraw fluid 
from the red blood-corpuscles, which shrink in size, and from 
muscle, the vitality of which is impaired. On the other hand, 
with very dilute solutions these all become swollen and soft- 
ened from the absorption of fluid. Salt solutions which are 
more concentrated than the blood-plasma are called hypertonic, 
those which are weaker than it, hypotonic, and those which are 
of the same osmotic pressure as the plasma, isotonic. When 
two solutions are separated by a semi-permeable membrane, 
neither of the salts in solution being able to penetrate the 
membrane, water accumulates on the side of the solution 
having the highest osmotic pressure. The osmotic pressure 
of a given substance is proportional to the number of molecules 
per volume of solution. A 0.7 per cent, solution of sodium 
chloride is called the normal or physiological saline solution 
because it is supposed to be isotonic or indifferent to the 
living tissues. As a matter of fact, however, it is probable 
that every cell and fluid in the body has its specific osmotic 
pressure, with a consequent variation in the concentration of 
the sodium chloride solution isotonic with it. The active tis- 
sues of the body contain a very large proportion of water, 
and physical continuity between these media is established by 
the inter-cellular and intra-cellular lymph. It would naturally 
be supposed, and experiment has shown this to be the case, 
that the normal distribution of water between the blood, lymph 
and solid tissues is maintained through the nicest physiological 
adjustment, the direct working factor of which is probably 
the force of osmosis. When the blood loses water, this is 
replaced by fluid drawn from the lymph, which in turn makes 



SODIUM. 185 

good its loss from the solid tissues. When a dilute solution of 
sodium chloride which has a lower osmotic pressure than the 
blood is introduced in excess into a vein, the hydrsemic 
plethora thus produced begins at once to diminish, owing to 
the rapid transudation of the fluid through the capillary walls, 
not of the muscles, but of the intestine and peritoneum. In 
the interchange of bodily fluids, however, the forces of filtra- 
tion and diffusion complicate those of osmosis in the trans- 
ference of material. For the occurrence of osmotic interchange 
the separating membrane must be permeable to water, but im- 
permeable to substances dissolved in it; and the capillary wall, 
which separates the blood from the lymph, is not of this char- 
acter, since through it there may take place both filtration 
due to difference of hydrostatic pressure and diffusion of sub- 
stances in solution. The laws of osmosis have been thus 
summarized: (1) Solutions separated by a membrane per- 
meable to water tend to have an identical molecular composition. 
(2) If the membrane is perfectly permeable to both solvent and 
dissolved substance the exchange of molecules will take place 
without change in pressure or volume. (3) If the membrane 
is less permeable to the dissolved substance than to the solvent, 
an increase of liquid, or increase of tension, will occur in the 
stronger solution. (4) If a membrane is differently permeable 
to one dissolved substance than to another, equimolecular solu- 
tions of the less diffusible substance will be hyperisotonic 
(hypertonic) to the more diffusible. 

In the mouth and fauces strong solutions of sodium chloride 
have an astringent action, while in the stomach they may have 
an emetic effect from the irritation caused by the withdrawal 
of fluid and the impartation of salt to the mucous cells. They 
are also capable of exerting a purgative action. A small amount 
of sodium chloride in the food, by rendering the latter more 
palatable, no doubt often has the effect of increasing the flow 
of gastric juice through reflex influence; but it would seem 
that stomachic digestion is not always improved by it, since it 
has been found that even small quantities diminish the acidity 



1 86 PHARMACOLOGY AND THERAPEUTICS. 

of this secretion. Mineral waters in which common salt is 
the chief constituent have no direct effect on the secretion, but 
appear to alter the nutrition of the gastric mucous membrane. 
Thus it is found that in some individuals the hydrochloric acid 
is increased by these waters, while in others it is lessened. 
Hypertonic and isotonic salt solutions are absorbed in the 
stomach and intestine, as well as hypotonic ones, and in order 
to explain this it is necessary to assume that there exists a 
constant natural tendency for fluids and some salts to pass 
inwards from the lumen of the gastro-intestinal tract. Hypo- 
tonic solutions are naturally absorbed rapidly, while isotonic 
ones are absorbed more slowly, because in their case the 
natural flow alone is active. With hypertonic solutions the 
absorption' is still slower, for the reason that the natural flow 
is at first antagonized by the osmotic pressure-current, which 
is in the opposite direction. Hence, for a time the fluid in 
the canal may actually be increased, by the abstraction of liquid 
from the blood; but as the absorption of salt is all the while 
taking place, the concentration of the fluid is gradually reduced 
until it becomes isotonic, and it is then absorbed. In the 
serous cavities it is stated that when salt solution is injected, 
absorption takes place in the same way as from the stomach 
and intestine, except that osmosis plays a more important part 
than in them. The blood and lymph are in turn affected by the 
processes occurring in the alimentary canal, and while the 
details of the changes which take place between these are 
not clearly understood, it is established that the absorption of 
salt, as well as of water, leads to an augmentation of the nor- 
mal exchange of the two fluids. Again, the changes in the 
blood and lymph are followed by an increased activity of the 
excretory organs. The flow of urine is increased to some 
extent by the absorption of salt solution from the alimentary 
canal, and to a notable degree by the injection of such a solution 
into the circulation, and this is believed to be the result of 
salt-action, and not of any direct effect produced upon the 
renal cells. The saliva is also increased, partly by a reflex 



SODIUM. 187 

from the mouth and partly because a portion of the salt is 
excreted by the salivary glands. While any salt solution caus- 
ing an acceleration in the movement of the fluids of the 
body necessarily tends to facilitate the excretion of waste 
products, the elimination thus caused is much smaller than 
has generally been supposed to be the case, and recent investi- 
gations indicate that salt tends to lessen the proteid metabolism 
through acting directly on the cells. This action is stated to 
be so slight, however, that the resulting fall in the nitrogen 
eliminated is concealed by the increase caused by the more 
complete flushing. Both sodium chloride and the potassium 
salts augment the salts of the urine. While carnivorous ani- 
mals and hunting peoples require no salt and often have a 
distaste for it, in consequence of their food containing so large 
a proportion of sodium salts, common salt forms an important 
article of diet with all creatures living largely or exclusively 
on vegetable food, in whom the potash in the food causes an 
intense craving for it. The cause of this desire for salt has 
been explained as follows : Blood plasma contains much sodium 
chloride, vegetable foods contain a large amount of potassium 
salts ; when, therefore, these salts of potassium reach the blood, 
potassium chloride and the sodium salt of the acid which was 
combined with the potassium are formed. This and the potas- 
sium chloride are excreted by the kidneys, and the blood loses 
its sodium chloride, which loss is therefore made up by taking 
sodium chloride with the food. Some doubt is said to have 
been recently thrown on this explanation by the discovery of 
certain African tribes living on vegetable substances alone, and 
yet using the ashes of plants, which contain more potash than 
soda, as civilized peoples use ordinary salt. As sodium chloride 
is the most important of the mineral constituents of the body, 
so far as regards its general distribution and the active part 
which it takes in the internal phenomena of nutrition, the 
ingestion of an adequate amount of it is essential to the mainte- 
nance of health, and the deprivation of it leads to general 
weakness, oedema and anaemia. 



1 88 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Chloride. 

Locally it is used to limit the action of silver nitrate when 
applied to mucous membrane, as a gargle in ordinary sore 
throat or in atomized solution in subacute and chronic affec- 
tions of the pharynx and larynx, in douches for the treatment 
of nasal catarrh and ozaena, as an injection for the vagina and 
rectum, and as a wash for indolent ulcers, hives and pruritus 
vulvae, as well as for the stings and bites of insects. As a rule, 
the solution used for affections of the mucous membrane should 
not exceed a strength of 1.20 gm. (20 gr.) to 500 c.c. (1 pint) 
of water, as stronger solutions are likely to be painful and to 
aggravate the disease. Rectal injections of strong solutions of 
salt, which by removing mucus serve to render the bowel unfit 
for the habitation of the parasite, constitute one of the best 
methods of treatment for the Oxyuris vermicularis. A solu- 
tion of it in whiskey is a popular remedy for muscular rheu- 
matism and for bruises, sprains, glandular swellings, etc., and 
hot salt enclosed in bags is a good application in lumbago and 
other forms of myalgia and in colic, dysmenorrhcea, toothache 
and other painful conditions. In the strength of Yi per cent, 
it makes an invigorating as well as cleansing bath, and in a 
5 per cent, solution has been recommended as more agreeable 
and useful than soap baths in subacute eczema, psoriasis, etc. 
Concentrated hot salt baths, like those of Droitwich and Nant- 
wich, are beneficial in chronic rheumatism and sciatica. Sea- 
bathing, as is well known, has a pleasant general stimulating 
effect, and its beneficial results are largely due to the abundant 
presence of sodium chloride in the water. 

Internally it is used at times as an emetic, and from 15 to 
30 gm. (1 to 2 tablespoonfuls) in 250 c.c. (y 2 pint) of tepid 
water are generally successful in causing a prompt evacuation 
of the stomach. In poisoning by silver nitrate it arrests the 
corrosive action by the formation of insoluble silver chloride. 
Its efficiency as an emetic is increased by combining it with 
mustard water. Administered in the form of natural mineral 
waters in which it is a principal ingredient, or in carbon dioxide 



SODIUM. 189 

water, it often proves of service in gastric disorders, and espe- 
cially dyspepsia attended with decomposition of food in the 
stomach, with resulting flatulence, acidity and pain. Salt meat, 
olives and other saline articles tend to prevent alcoholic in- 
toxication, and enemata of salt and water are employed with 
success to rouse drunkards from their lethargy or abate their 
delirious outbreaks. In conditions where the body has lost 
much fluid, as from haemorrhage and in Asiatic cholera, life has 
repeatedly been apparently saved by the intravenous injections 
of solutions of salt in distilled or boiled water, with the addi- 
tion sometimes of a small amount of sodium sulphate or car- 
bonate, calcium chloride, or other alkali ; and normal saline 
solution is now commonly given in this way or by hypoder- 
moclysis (see p. 3), as a substitute for transfusion of blood. 
This may be prepared by dissolving 4 gm. (60 gr.) of common 
salt in 500 c.c. (1 pint) of boiling water, and allowing the solu- 
tion to cool to 37. 7° C. (ioo° F.). It is often desirable, how- 
ever, to use it at a considerably higher temperature than this. 
Recently an effort has been made to secure a solution which 
might be free from the disadvantages found in the actual use 
of saline infusions whether used by the intravenous method, 
by hypodermoclysis or by injection into the peritoneal cavity. 
Although its content of sodium chloride is higher than that 
given above the following has been lately recommended: So- 
dium chloride, 0.9; calcium chloride, 0.026; potassium chloride, 
0.01 ; distilled water, 99.064. Salt solution has also been em- 
ployed in uraemia and similar intoxications, and in such condi- 
tions subcutaneous injection is preferred by some. In the case 
of insane patients who refused to take food the use of salt solu- 
tion by hypodermoclysis has sometimes been found of service, 
as it has the effect of exciting hunger and thirst. In poisoning 
by carbon dioxide and by coal gas good results have been re- 
ported from this procedure or the intravenous injection of a 
salt solution, after a preliminary bleeding. Intestinal lavage 
with normal saline solution, by means of the rectal irrigator, 
is almost certain to have a marked diuretic effect, as it has 



I9O PHARMACOLOGY AND THERAPEUTICS. 

been pointed out that the association of action between the 
lower bowel and the kidneys is such that a movement of the 
bowels can scarcely take place without simultaneously in- 
ducing a urinary flow. It is therefore of great service in various 
conditions, and especially acute nephritis. In colitis, particularly 
when chronic, medicinal remedies not infrequently fail to com- 
plete the cure until supplemented by the local effects of this 
lavage. The beneficial influence of the enteroclysis may be en- 
hanced by the addition to the fluid of antiseptic and anodyne 
agents. Auto-infection from retention of putrid contents in 
the colon may give rise to grave cerebral symptoms, and the 
same conditions are often met with in cholera infantum; here 
such intestinal irrigation is indicated, both to combat the toxic 
infection and to secure the beneficial effects of the saline on 
the blood, after it has been drained of its salts by the watery 
evacuations. This procedure may also prove valuable against 
the toxaemia in fevers, particularly typhoid fever. 

8. SODII NITRAS.— Sodium Nitrate. Dose, 1 gm.; 15 gr. 

Action of Sodium Nitrate. 
Its action is practically the same as that of potassium nitrate, 
except that it is much less depressant to the heart. In dilute 
solution it may be taken in large amount without producing any 
effect except diuresis. It is a less efficient diuretic than potas- 
sium nitrate, however, as it lacks the stimulating influence upon 
the kidney which is due to the potassium constituent of the 
latter salt. In concentrated form it acts as a gastro-intestinal 
irritant and may cause purgation, with the result of lessening 
the force or frequency of the heart's action and of lowering 
the temperature. 

Therapeutics of Sodium Nitrate. 
At the present day it is very rarely employed in practical 
medicine. Formerly it was chiefly used in diarrhoea and dysen- 
tery, in daily doses of from 30 to 60 gm. (1 to 2 oz.) dissolved 



SODIUM. I9I 

in a large quantity of water. It has been considered of service 
in relieving maniacal excitement, in daily quantities of from 3 
to 5 gm. (45 to 75 gr.), and in two patients who suffered from 
epilepsy of psychical origin it is said that the attacks could be 
prevented by the exhibition of 6 gm. (1^2 dr.) immediately 
after the appearance of the aura. 

9. SODII ACETAS.— Sodium Acetate. Dose, 1 gm.; 15 gr. 

Action of Sodium Acetate. 
The same as potassium acetate, both resembling the chlorides 
and therefore owing any effect they possess to the salt-action. 
In the. body, however, they are oxidized, with the formation of 
carbonates, and hence their action before absorption is that of 
the chloride, and afterwards that of the carbonate. The re- 
sult is that the alkalinity of the blood and of the urine, as 
well as the amount of the latter, is increased. A mixture of 
equal parts of sodium acetate and potassium nitrate explode 
with great violence. 

Therapeutics of Sodium Acetate. 
It is employed principally to yield acetic acid by the action 
of sulphuric acid, and although it has decided diuretic prop- 
erties, is seldom prescribed medicinally. By some, however, it 
is considered more efficient as a diuretic, as well as milder and 
less apt to derange the digestion, than potassium acetate. It 
has been given as an antacid in acute rheumatism and as a 
diuretic in dropsies, and also used in irritation of the genito- 
urinary apparatus and gout. 

10. SODII CHLORAS.— Sodium Chlorate. Dose, 0.250 gm. (250 
milligm.) ; 4 gr. 

Action of Sodium Chlorate. 
Practically the same as that of potassium chlorate. The 
effects produced by both salts are principally due to their 
chlorate ion. 



192 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Chlorate. 
It has never been used to anything like the extent of the 
potassium chlorate, but is occasionally employed as a substi- 
tute for the latter in affections of the mouth and throat. Its 
greater solubility, it may be said, permits of stronger solutions. 
As a gargle or wash a 2 to 5 per cent, solution may be pre- 
scribed. It has been used with asserted remarkable results in 
cancer of the stomach, but the large doses employed would seem 
to be attended with considerable danger from chlorate poison- 
ing. 

11. SODII PYROPHOSPHAS.— Sodium Pyrophosphate. Dose, 2 
gm.; 30 gr. 

Action of Sodium Pyrophosphate. 
Sodium pyrophosphate has the same therapeutical action as 
sodium phosphate. 

Therapeutics of Sodium Pyrophosphate. 
Its principal use is in pharmacy, and it is rarely, if ever, 
employed as a medicine. 

12. SODII CITRAS.— Sodium Citrate. Dose, 1 gm.; 15 gr. 

Action of Sodium Citrate. 
It is a cooling and mild purgative, similar in its action to 
magnesium citrate. 

Therapeutics of Sodium Citrate. 
It may be given in cases where a pleasant saline laxative is 
required. 

13. SODII iETHYLAS (Not official).— Sodium Ethylate. 

Preparation. 
Liquor Sodii iEthylatis (Not official). — Solution of Sodium 
Ethylate. 



SODIUM. I93 

Action of Sodium Ethylate. 
When it is applied to living tissues the following effects 
have been observed: 1, a removal of water from the tissue; 2, 
the destructive action of the resulting caustic soda; 3, coagula- 
tion from the alcohol that is reproduced; 4, prevention of 
decomposition in the resulting dead tissue. It is stated that 
the liberated alcohol coagulates the albuminous compounds in 
its neighborhood, and thus limits the caustic action of the soda, 
and that the red blood-corpuscles become disintegrated, and 
then crystalline, while the white are for a time unaffected. 
When used for local pathological conditions it affects the sur- 
rounding healthy skin to but a slight extent, its action being 
restricted to the spot on which it is applied; and it produces 
scarcely any scarring. As compared with the action of nitric 
acid, there is but little destruction of the epidermis, while the 
pain caused by it is less severe than that from the acid. 

Therapeutics of Sodium Ethylate. 
It is used exclusively for its local effects, and is by some 
considered the best of all caustics. Its corrosive action is very 
speedy and energetic, and it has been employed especially for 
the destruction of naevi. It is customary to apply it, by 
means of a glass rod, for two or three days successively, and 
when the eschar thus formed has fallen off the treatment is 
repeated, if necessary. The pain caused by it may be mitigated 
by mixing it with laudanum, and in pendulous vascular tumors 
the risk of too great haemorrhage may be avoided by diluting 
the ethylate with alcohol, so as to promote coagulation. This 
caustic is also used with advantage in a variety of other condi- 
tions, such as tattoo, hypertrichosis, warts, moles, callous ulcers, 
nasal polypus, haemorrhoids, lupus, epithelioma, and melanotic 
growths. A 10 per cent, watery solution, applied after curet- 
ting, has been found valuable in the treatment of lupus erythema- 
tosus, and it is stated that a 20 per cent, liniment, made with 
olive oil, if well rubbed in daily, will usually cure psoriasis in 
a comparatively short time. Sodium ethylate has also been 



194 PHARMACOLOGY AND THERAPEUTICS. 

employed in ringworm and other skin affections. Applied di- 
rectly to the unbroken skin, it is asserted that its destructive 
action is less painful than would be expected, and that when 
pain is felt it may be quickly checked by dropping upon the 
part a little chloroform. The caustic alcohols may be used 
in combination with local anaethesia from cold. Potassium and 
sodium alcohol, added to amyl-hydride, dissolve the hydride 
and produce a caustic solution. A part rendered quite dead to 
pain by freezing with ether spray may be directly destroyed, 
it is said, by the subcutaneous injection of caustic alcohol — a 
practice very important in the treatment of poisoned wounds; 
and it has been suggested that cystic tumors might be cured 
by such injections, after destruction of the sensibility of the 
parts by cold. 

AMMONIUM. 

1. AQUA AMMONITE FORTIOR.— Stronger Ammonia Water. 

Preparation. 
Spiritus Ammonias. — Spirit of Ammonia. Dose, 1 c.c; 15 n\. 

2. AQUA AMMONIAS.— Ammonia Water. Dose, 1 C.C.; 15 H\.. 

Preparations. 

1. Linimentum Ammonise. — Ammonia Liniment. (Volatile 
Liniment.) 

2. Spiritus Ammoniae Aromaticus. — Aromatic Spirit of Am- 
monia. Dose, 2 c.c; 30 n\. 

Action of Solutions of Ammonia. 
External. — Applied to the skin ammonia solutions of moderate 
strength are rubefacient. Strong solutions cause a sensation 
of burning pain and, if the part is covered, will give rise to 
vesication. Ammonia differs from the other alkalies in being 
more volatile, in consequence of which it penetrates more rap- 
idly and deeply. It passes through the stratum corneum of the epi- 
dermis without dissolving it, and produces the blisters by its ac- 



AMMONIUM. I95 

tion on the lower layers of the skin. At the same time it is less 
corrosive and less enduring in its effects than the fixed alkalies, 
although, if the application is continued sufficiently long, 
sloughing will result. 

Internal. Eyes, Nose and Air Passages. — Vapor of ammonia, 
in contact with the eye, causes severe pain and inflammation. 
When inhaled it is also irritating, occasioning smarting, sneez- 
ing, lachrymation and coughing, with reflex acceleration of the 
pulse and respiration. If sufficiently concentrated, it is likely 
to cause spasm of the glottis or such swelling of the mucous 
membrane of the larynx and trachea as to induce asphyxia. 
Animals immersed in such vapors become asphyxiated, and 5 
parts of ammonia in 10,000 are considered dangerous. 

Stomach. — In the mouth, fauces, oesophagus and stomach 
concentrated solutions produce corrosions similar in character 
to those resulting from caustic potash and soda, but as the 
gas evaporates rapidly from ammonia solutions, some of the 
vapor generally escapes into the respiratory passages, and in 
the manner described tends to produce asphyxia, which may 
result in death very suddenly. In dilute solution ammonia acts 
as a mild gastric stimulant. Like other alkalies, it renders the 
gastric juice less acid and tends to liquefy the mucus in the 
stomach. 

Skin, Mucous Membrane, and Salivary Glands. — Ammonia 
and its salts have considerable effect in increasing the secre- 
tions, especially the saliva, mucus and perspiration. The 
diaphoresis has been attributed to their action on the central 
nervous system, and the increase in the saliva and mucus to 
a reflex stimualtion from mucous membranes due to a salt action, 
to direct stimulation of the secreting centres, and to local 
salt-action upon the secretory cells themselves. It is considered 
doubtful, however, whether these agents, although having a 
direct action upon the central nervous system when injected 
into the circulation, are capable of producing any such effect 
when they are absorbed from the stomach. The ammonium 
salts are said to be excreted largely into the mouth by the saliva, 



I96 PHARMACOLOGY AND THERAPEUTICS. 

as also by the lungs, mainly in the form of carbonate. In 
this way the local action is exerted twice (when the salt is 
applied and when it is excreted), and this excretion in the 
form of carbonate also tends to liquefy the mucus on account 
of the alkaline action. 

Blood. — Little is known of the behaviour of ammonia in the 
blood, although when injected in poisonous quantities it has 
been found to prevent the blood from taking up oxygen. 
It was at one time supposed by some observers that the coagu- 
lation of the blood was caused by the escape of ammonia, but 
it is now known that this is not the case. Still, ammonia helps 
to maintain the fluidity of the blood, while its presence, in 
sufficient quantity, serves to hold the fibrin in solution. Thus, 
having the property of dissolving fibrin, it is believed to diminish 
the local liability of the blood to coagulate, and also to be 
capable of dissolving clots, in cases of thrombosis. 

Heart and Circulation. — Upon the circulation ammonia acts 
as a powerful, but fleeting stimulant. When it is inhaled, the 
irritation of the nasal mucous membrane causes a reflex stimula- 
tion of the vaso-motor centre, and consequent constriction of 
the arterioles and increased blood-pressure. The cardiac action 
may be temporarily slowed by inhibitory reflexes. Also when 
ammonia is injected in moderate amounts into the circulation, 
the blood-pressure rises from the contraction of the peripheral 
vessels caused by stimulation of the vaso-motor centre. The 
heart itself is sometimes slowed from increased activity of the 
inhibitory centre, and sometimes accelerated; whether in 
consequence of action on the cardiac muscle or on the accelera- 
tion centre is not known. The pulse-rate and the pulse-force, 
as well as the blood-pressure, are usually increased, and the 
rise in the arterial pressure is followed, if the dose has been 
sufficiently large, by a decided fall, ending in permanent diastolic 
arrest of the heart. If by means of intravenous injection the 
ammonia reaches the heart in large amount in concentrated 
form, the organ at once ceases to beat, in consequence of 
paralysis of its muscular walls. Any effect that solutions of 



AMMONIUM. 



I 9 7 



ammonia, when taken by the mouth, may have in stimulating 
cardiac action, is probably not due to a direct influence upon 
the heart, but to an action exerted reflexly from the gastric 
irritation. 

Respiration. — From the reflex stimulation of the respiratory 
centre in the medulla, when ammonia is inhaled, the respiration 
is at first checked, and then rendered fuller and deeper. So, 
when the drug is injected subcutaneously or intravenously the 
respiration often ceases for a moment, and then becomes very 
much accelerated, while in some instances it is deepened; this 
increase in respiration being due to stimulation of the respira- 
tory centre. As to the preliminary pause, it has been attributed 
by some to action on the vagus terminations in the lungs, while 
this is denied by others, and it is thought probable that it is 
due simply to excessive stimulation of the respiratory centre. 
The breathing finally stops in respiratory tetanus. 

Nervous System and Muscles. — The action on the central 
nervous system consists of a stimulation, especially of the 
medulla oblongata and spinal cord. According to some ob- 
servers the brain is found to be rather depressed, so that there 
is somnolence. Others believe that the brain is first stimulated, 
and that this action inhibits the reflexes. Then, as the stimula- 
tion passes downwards, the spinal cord is acted on in turn, and 
the reflexes are exaggerated. The rise of arterial pressure and 
the quickening of the respiration, from the action on the medul- 
lary centres, have already been mentioned. When the drug is 
injected into the circulation tetanic convulsions may occur, 
though appearing rather late, and they resemble strychnine 
spasms quite closely. As they persist after division of the 
cervical cord and destruction of the brain and medulla ob- 
longata, they would appear to be due to changes in the spinal 
cord such as are observed in poisoning by strychnine. During 
the convulsions the respiration is arrested and the blood-pres- 
sure becomes extremely high. If the amount injected into the 
circulation be sufficiently large, the stimulation is followed by 
paralysis of the central nervous system, and death is caused by 



I90 PHARMACOLOGY AND THERAPEUTICS. 

asphyxia. The muscles are acted on by ammonia in much the 
same way as by potassium, although it is stated that a prelimi- 
nary stage of augmented irritability not met with in the case 
of the latter has been observed by some investigators. Under 
the effects of potassium the contraction of the muscle of the 
frog appears to be somewhat greater in height, though shorter 
in length, while there is less tendency to contracture; and muscle 
exposed in a solution of potassium chloride dies very much 
sooner than in an isotonic solution of sodium chloride. 

Kidneys. — Ammonia differs from the -fixed alkalies in not 
increasing the alkalinity of the blood and in not reducing the 
acidity of the urine or rendering it alkaline. This is because 
it is changed to urea in the body, and is excreted in this form 
in the urine. The flow of urine is sometimes, but not always, 
increased by the administration of the salts of ammonia; when 
this is the case it is said to be due simply to the increase of 
urea. 

Therapeutics of Solutions of Ammonia. 

External. — The stronger water of ammonia is sometimes 
used as a rubefacient and vesicant. This solution, however, 
will generally be found too strong for use in its unmixed state, 
and where a prompt and sufficiently powerful counter-irritant 
effect is indicated, as is sometimes the case in various neuralgic, 
gouty, rheumatic, spasmodic and inflammatory affections, it 
may be combined, in the proportion of five parts to eight, with 
a diluent liquid composed of spirit of camphor and rosemary. 
If a very quick effect is called for, the proportion should be five 
to three. A convenient method of application is to fill the 
cover of an ointment-box, or other suitable receptacle, with 
lint, and, having saturated it with the lotion, press it upon 
the part. The ammonia is thus prevented from escaping, and 
a definite boundary given to the action desired. The less 
diluted mixture will generally produce rubefaction in from one 
to eight minutes, and vesication in from three to ten minutes. 
In severe neuralgias the skin may be blistered at points where 
the affected nerve is found to be tender. Care should be always 



AMMONIUM. I99 

taken, however, that the application should not be continued too 
long, as sloughing may then result. A salt of morphine may- 
be added to the solution employed. In some cases " thimble- 
blistering " is advised ; in which small areas over the painful 
spots are vesicated by means of undiluted stronger water of 
ammonia dropped upon absorbent cotton and confined with a 
thimble or watch-glass in contact with the skin. Ammonia is 
not often used for epispastic purposes, as the blisters produced 
by it are more painful and slow to heal than those of other 
vesicants. It is especially applicable, however, when vesication 
is desired in cases of renal disease, in which cantharides is 
contra-indicated. Aqua Ammonias is a very good application 
for the stings and bites of insects. The stronger water is often 
applied in snake-bite, but so far as any antidotal action is con- 
cerned it would seem to be of no service, as ammonia has been 
shown to have no effect on the toxalbumins of snake-poison. 
The inhalation of Aqua Ammonias is of great value in cases 
of syncope ; held to the nostrils of persons who have fainted, 
by its effect on the mucous membrane, it usually produces, 
through reflex influence, very prompt stimulation of the heart 
and respiration. In all cases of suspended animation, whether 
from syncope or asphyxia, it may be employed, but with caution, 
on account of the possibility of its giving rise to inflammation 
of the fauces, glottis and larynx. Ammonia is the basis of most 
of the " smelling salts " in popular use, the ordinary form of 
which consists of the carbonate reinforced with some of the 
strong solution of ammonia and flavored with oil of lavender. 
Ammonia water is much used in liniments, usually combined 
with olive or other oil, and also in washes to prevent the hair 
from falling out or to stimulate its growth. Amenorrhoea, as 
well as leucorrhcea, is said to have sometimes been successfully 
treated by vaginal injections of a weak solution of ammonia. 
Such solutions have also been used in the treatment of super- 
ficial burns and frost-bite, and, in association with hot water, for 
sponging the surface for the relief of general exhaustion or 
depression of the nervous system in low fevers. The early 



200 PHARMACOLOGY AND THERAPEUTICS. 

inhalation of dilute vapor of ammonia may perhaps sometimes 
arrest the development of catarrhal affections of the throat 
and air passages, and also prove of service in chronic dry- 
ness of the pharynx and chronic hoarseness. It has been known, 
it is said, to delay or prevent the paroxysms of whooping-cough 
and epilepsy. 

Internal. — In the stomach ammonia in solution acts as a 
stimulant antacid, and is useful in heart-burn, sick-headache, 
etc., but in dyspeptic conditions it is not used alone so much 
as in combination with the carbonate in the Spiritus Ammoniae 
Aromaticus. In sudden paralysis of the heart from chloroform 
narcosis, poisonous gases, or toxic agents such as hydrocyanic 
acid, nicotine, etc., or in collapse from any cause, it may be 
intravenously injected — 4 to 8 c.c. (1 to 2 11. dr.) of Aqua 
Ammoniae with an equal quantity of water. Injected subcu- 
taneously, it almost invariably produces a slough. Intravenous 
injections of ammonia are also called for when sudden throm- 
bosis of a large venous trunk occurs, as, for example, in the 
pulmonary artery, after uterine haemorrhage. They may even 
be employed when thrombosis is threatened, but has not actually 
taken place, as in the puerperal state, after free haemorrhage, 
when the circulation is depressed from weak heart. In chloro- 
form narcosis this procedure not infrequently fails, and the 
reason for this is believed to be because the heart stops sud- 
denly and completely, so that before the injection can be prac- 
ticed the cardiac ganglia have entirely ceased to functionate. 
The opinion has been expressed that 'failure has sometimes re- 
sulted in other classes of cases because a sufficient quantity of 
ammonia was not employed, and a case is on record in which 
a patient is stated to have been saved from inevitable death 
from the effects of the gases of a privy vault by no less than 
twelve intravenous injections of the stronger water of ammo- 
nia, the whole amount thrown into the circulation being 8.624 
c.c. (140 ui). The repetition of the injection should naturally 
depend on the effects noted, and it is advised that the limit to 
the amount of ammonia used should be determined by the state 



AMMONIUM. 20I 

of the heart. Notwithstanding the negative results obtained in 
experimental researches, many instances have been reported in 
which ammonia injections seemed to be efficacious in poisoning 
by venomous serpents. In such cases the beneficial results were 
no doubt due to the prompt and energetic stimulation, rather 
than to any antidotal value of the remedy. 

3. AMMONII CARBONAS.— Ammonium Carbonate. (Bakers' Am- 
monia. Hartshorn. Sal Volatile.) Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Preparation. 
Elixir Ferri, Quininse et Strychninae Phosphatum. — Elixir 
of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; 1 
fl. dr. 

Action of Ammonium Carbonate. 
The pharmacological effects of the carbonate are similar to 
those of solutions of ammonia. Although not so corrosive as 
the latter, when swallowed in sufficient quantity it acts as an 
irritant poison. Slight gastric irritation is produced by moder- 
ate amounts, and nausea and vomiting by larger doses. It 
has expectorant properties of great value, as it not only in- 
creases the bronchial mucous secretion and renders it more fluid, 
but reflexly stimulates the respiratory centre in the medulla 
oblongata. In the urine it is excreted as urea. 

Therapeutics of Ammonium Carbonate. 
The carbonate, either in solution, or in the form of aromatic 
spirit of ammonia, is given very frequently in cases of collapse 
and heart-failure, or where such conditions are threatened. 
Here the stimulating influence exerted by it is probably not, as 
has been generally supposed, directly upon the heart and 
respiratory centre in the medulla, but a reflex effect resulting 
from the gastric irritation. When thrown into the circulation, 
however, either by subcutaneous or intra-venous injection, there 
can be no question that it has a direct action upon the medullary 
centres, and thus causes a powerful, though evanescent, stim- 



202 PHARMACOLOGY AND THERAPEUTICS. 

illation. In less serious depression resulting from various 
causes Spiritus Ammonise Aromaticus is a favorite remedy, 
and generally answers very well for temporary purposes; giv- 
ing a feeling of increased strength, or even of exhilaration, and 
increasing the warmth of the surface. It is useful as a gastric 
stimulant and carminative, and is employed especially in cases 
of headache attended with acidity of the stomach and flatulent 
eructations. It is also of service in the sour stomach and 
tympanites met with particularly in hysterical women, and 
will sometimes prevent or abort paroxysms of hysteria. In 
nervous headaches, whether attended with nausea or not, it 
often affords relief. Ammonium carbonate is likely to prove 
successful in the treatment of delirium tremens when the latter 
is associated with cerebral anaemia and weak heart action. It 
sometimes counteracts even a high degree of alcoholic intoxi- 
cation, and is serviceable in the dyspepsia of drunkards from 
its stimulant and antacid properties, as well as its action in 
dissolving the tenacious mucus coating the stomach. In doses 
of from .30 to .60 gm. (5 to 10 gr.), administered with .60 c.c 
(10 ni) of tincture of capsicum in 30 c.c. (1 fl. oz.) of some 
bitter infusion, it is very efficient in relieving the sinking sen- 
sations and craving for stimulants experienced by subjects of 
alcoholism. It is a valuable cardiac and nervous stimulant in 
syncope, heart-exhaustion, and all typhoid conditions, and may 
therefore at times be employed with advantage in adynamic 
forms of pneumonia, scarlet fever, measles, small-pox and 
erysipelas, as well as in typhus and typhoid fevers. As it is 
quickly eliminated, it is best given in small doses repeated at 
short intervals. By some, however, its administration in typhus 
and typhoid fevers has been regarded as improper, on the 
ground that in these diseases the ammonia in the blood is 
increased beyond the normal. In pneumonia it has been pointed 
out that to stimulate the heart merely, when an obstacle exists 
in the pulmonary circulation, is of doubtful utility; but am- 
monium carbonate, by liquefying the exudation, also relieves 
obstruction of the air-sacs, and is thus a remedy of great value. 



AMMONIUM. 203 

It is sometimes prescribed with good effect in infusion of 
senega, which is a stimulant expectorant. In bronchitis and 
broncho-pneumonia it is often given in association with other 
expectorants, and is perhaps most used in the case of children 
and old people. It is especially esteemed in the capillary bron- 
chitis of the young, and is employed by surgeons in the treat- 
ment of children after operations to overcome the respiratory 
and circulatory depression produced by the anaesthetic. In 
rather large and frequently repeated doses it may prove effica- 
cious in aborting a cold. On account of its alkalinity, ammo- 
nium carbonate should not be prescribed in a mixture with 
either the vinegar or syrup of squill, the latter being made from 
the vinegar. It is sometimes used as an emetic, in doses of 2 
gm. (30 gr.) for an adult, and is less depressant than many 
other agents employed for this purpose. In diabetes it has been 
thought to sometimes prove of service, and its use has been 
strongly recommended in the treatment of cystinuria. 

4. AMMONII CHLORIDUM.— Ammonium Chloride. (Sal Am- 
moniac, Ammonium Muriate.) Dose, 0.500 gm. (500 milligm.) ; 7Y 2 
gr. 

Preparation. 
Trochisci Ammonii Chloridi. — Troches of Ammonium Chlo- 
ride. 

Action of Ammonium Chloride. 
Applied locally to mucous membranes, it stimulates their se- 
cretion. After absorption it also acts upon these membranes, 
rendering the secretions of the stomach and the bronchial 
mucous membrane less tenacious, as well as increasing their 
amount. Injected into the circulation, it has, like ammonia 
and its carbonate, a stimulating action on the central nervous 
system, but when absorbed from the alimentary canal, it ap- 
parently has no such direct effect, though reflexly it may cause 
some stimulation. When swallowed in considerable quantity 
it may induce irritation and vomiting, but only through its 
action as a salt. Solutions of the chloride are rapidly absorbed 
from the stomach and intestine, and permeate the red blood- 



204 PHARMACOLOGY AND THERAPEUTICS. 

corpuscles with great facility. It apparently has some action 
on the liver, and it is thought probable that this is explained 
by its increasing the excretion of urea by the kidneys. In the 
body it is changed to urea, and this transformation seems to 
take place principally in the liver. When urea is formed from 
it hydrochloric acid is liberated in the tissues, and this, it is 
stated, would act as a poison, were it not neutralized at once 
by ammonia being formed in the tissues themselves. It seems 
to have some effect in increasing the urine, as well as the 
secretion of the salivary and sweat glands. It is said to 
be excreted to some extent by the salivary glands, but its elimi- 
nation takes place principally by the kidneys. 

Therapeutics of Ammonium Chloride. 
In consequence of its decided action on mucous membranes, 
ammonium chloride (either in its nascent state, as generated 
by the action of hydrochloric acid on ammonia, or in the form 
of an atomized watery solution), is largely used by inhalation 
in pharyngitis, otitis media, laryngitis, bronchitis, etc., and 
especially when these conditions are chronic. In both acute 
and chronic pharyngitis and bronchitis it is frequently admin- 
istered in the form of troches or compressed tablets. It is also 
a favorite ingredient of expectorant mixtures. Combined with 
potassium iodide, tincture of ipecacuanha, and brown mixture, 
it is regarded as of special value in acute catarrhal pneumonia. 
It is sometimes employed with good effect in so-called bilious- 
ness, with coated tongue, decreased secretion of the intestinal 
juices, scanty, high-colored urine, etc., and in various hepatic 
affections, such as chronic torpor of the liver, chronic hepatitis, 
and catarrh of the bile-ducts with jaundice, it is often of great 
service. In the first stage of cirrhosis it has also been found 
useful by some authorities. The disagreeable taste of the drug 
may be covered to a considerable extent by liquorice or by 
the fluidextract of taraxacum. The former would naturally 
be preferred as a vehicle for affections of the respiratory ap- 
paratus, and the latter in hepatic disorders. In these taraxacum 



AMMONIUM. 205 

is used by many practitioners, although it would appear that 
there is no sufficient ground for the belief that it has a specific 
action on the liver. Formerly ammonium chloride was some- 
times given in malarial fever, and large doses of it have been 
recommended in neuralgia. By those who have found it useful 
it is believed to be chiefly serviceable in neuralgias depending 
upon cold, and tincture of aconite has sometimes been asso- 
ciated with it. It has also been thought beneficial in myalgia 
and chronic muscular rheumatism. Like the other preparations 
of ammonia, it is employed in acute alcoholism, and 2 gm. (30 
gr.) in 250 c.c. ( l / 2 pint) of water, swallowed at one draught, 
is said to be sometimes remarkably efficient in the case of 
patients on the verge of delirium tremens. By some it is con- 
sidered a very useful remedy in the subacute gastric and intes- 
tinal catarrh of children, in doses of from .12 to 1 gm. (2 to 
: 5 & r -)> preferably given with liquorice and water to mask the 
taste. It is also beneficial in some cases of gastric catarrh in 
adults, and .60 gm. (10 gr.), given half an hour before meals, 
it is asserted, will afford extraordinary relief in painful dys- 
pepsia due to hyperacidity of the stomach. In tropical dysen- 
tery good results have been reported from its use. When 
this remedy is administered in the form of compressed pills 
it is advised that a large draught of water or milk be taken 
simultaneously to protect the stomach. The local application 
of ammonium chloride is not resorted to at the present time 
to such an extent as was formerly the case. Its stimulating 
action has been made use of to arrest the progress of gangrene, 
especially of the senile variety ; cataplasms or local baths con- 
taining it being applied according to the situation of the dis- 
ease. In weak solution it has been employed as a wash for 
ulcers and a vaginal injection for leucorrhoea, and in stronger 
solution as a stimulant and resolvent in contusions, contused 
and lacerated wounds, sprains, enlarged bursae and joints, in- 
dolent tumors, etc. A solution of from 8 to 15 gm. (2 to 4 dr.) 
to 500 c.c. (1 pint) of water removes ecchymosis from con- 
tusions, and is also applicable to subacute epididymitis. In 



206~ PHARMACOLOGY AND THERAPEUTICS. 

local inflammations the cold produced by it in dissolving may 
sometimes be taken advantage of. Five parts of ammonium 
chloride with 5 parts of potassium nitrate and 16 parts of 
water will cause a very considerable lowering of the thermom- 
eter, and such a mixture, applied in a bladder, has been em- 
ployed for the reduction of hernial tumors. It forms a useful 
ingredient in errhine powders, and a solution of 8 gm. (2 dr.) 
to 120 c.c. (4 fl. oz.) of water is an efficient topical application 
in rhus poisoning. 

5. LIQUOR AMMONII ACETATIS.— Solution of Ammonium Ace- 
tate. (Spirit of Mindererus.) Dose, 16 C.C.; 4 fl. dr. 

Action of Ammonium Acetate. 
Locally the acetate acts in the same way as the chloride, but 
in the tissues it undergoes oxidation and the whole of it is 
converted into urea; so that while the urea of the urine is in- 
creased, there is no increase in its ammonia. In the case of 
the chloride, the net result of the effects produced upon the 
system is that the urea excretion is but little changed, while 
the ammonia of the urine is much increased. Ammonium ace- 
tate causes an increase not only of the solid constituents of the 
urine, but also of its fluid, and it stimulates the secretion of the 
skin as well as that of the kidneys. 

Therapeutics of Ammonium Acetate. 
On account of its diaphoretic and diuretic properties, it is 
sometimes prescribed in fever, either alone or together with 
more powerful remedies. Except as a vehicle for the latter, 
however, it is much more rarely employed now than formerly. 
In typhoid fever it has been found that the diarrhoea may be 
increased by it. It used to be given very frequently combined 
with spirit of nitrous ether, and in mild febrile conditions in 
children is still employed to some extent thus associated. 
Solution of ammonium acetate sometimes proves very grateful 
to fever patients when administered with an equal quantity of 
carbon dioxide water. In sick headache from 4 to 8 c.c. (1 to 



LITHIUM. 207 

2 fl. dr.) repeated every hour, is often very efficacious, and this 
remedy may also be given with good results in acute alcoholism. 
As a diuretic it is employed as an adjuvant in the treatment of 
scarlatinous dropsy and of chronic Bright's disease. 

6. AMMONII NITRAS (U. S. P., 1890; no longer official).— Am- 
monium Nitrate. 

Action of Ammonium Nitrate. 
It has the general action of the nitrates, being a gastro- 
intestinal irritant and renal stimulant. 

Therapeutics of Ammonium Nitrate. 
It is used to prepare nitrous oxide gas, freezing mixtures, 
and artificial cold applications. 

LITHIUM. 

1. LITHII CARBONAS.— Lithium Carbonate. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 

2. LITHII CITRAS.— Lithium Citrate. Dose, 0.500 gm. (500 mil- 
ligm.) ; 71/2 gr. 

Preparation. 
Lithii Citras Effervescens. — Effervescent Lithium Citrate. 
Dose, 8 gm.; 120 gr. 

3. LITHII VANADAS (Unofficial).— Lithium Vanadate. Dose, 
.003 gm.; ^ gr. 

Action of Lithium Carbonate and Citrate. 
Lithium is believed to possess an action midway between 
sodium and potassium, but comparatively little is known of the 
physiological effects of its salts. When given to dogs by the 
mouth in sufficient quantity they have been found to produce 
severe gastro-intestinal irritation, with diminished secretion of 
bile. Injected into mammals they have caused marked weak- 
ness, gastric disturbance, diuresis, increasing dyspnoea, fall of 
temperature, and death (often preceded by convulsions), from 



208 PHARMACOLOGY AND THERAPEUTICS. 

arrest of the respiration. The heart of the frog is arrested in 
diastole, but lithium acts much less powerfully on the mamma- 
lian heart than potassium. It appears to be depressant to the 
motor nerves, as well as the spinal cord, and to weaken muscu- 
lar contraction. These salts in medicinal doses rarely give rise 
to any definite symptoms in man, unless it be an increased flow 
of urine, but large quantities may cause gastric derangement 
and possibly some muscular twitching. In the body lithium 
slightly increases the nitrogen excretion. The citrate is less 
disagreeable to the taste and less liable to irritate the stomach 
(though in occasional instances it produces nausea and vomit- 
ing) than the carbonate, and its effects are the same, as the 
citric acid is consumed in the system and a lithium carbonate 
formed and excreted in the urine. Lithium salts are capable of 
rendering the urine very strongly alkaline. 

Therapeutics of Lithium Carbonate and Citrate. 
Lithium salts are useful alkaline remedies, and are employed 
to a considerable extent in the treatment of rheumatism and 
gouty affections, especially of a subacute and chronic charac- 
ter. They have been much lauded in the so-called uric diathesis, 
but while outside the body lithia exhibits great solvent power 
over uric acid, with which it forms a biurate that is more 
soluble than the corresponding salts of the other alkali metals, 
it has been pointed out that in the system it has a greater 
affinity for the acid sodium phosphate in the blood, and prac- 
tically leaves the uric acid to itself. There is unquestionably a 
large amount of clinical evidence going to show the beneficial ef- 
fects of lithium salts in gouty cases and where there is a ten- 
dency to uric acid, sand and gravel ; but there is reason to believe 
that in the body fluids the amount of lithium introduced by 
ordinary dosage can exercise no solvent influence upon gouty 
deposits, and it is now the opinion of many of the best authori- 
ties that the large amount of water generally taken with lithia 
has more to do with relieving the conditions in question than 
the drug itself. Most of the popular lithia waters contain 



MAGNESIUM. 209 

lithium salts only in minute proportions, and whatever value 
is to be ascribed to them is no doubt principally due to their 
effect in dissolving effete materials resulting from imperfect 
elimination of tissue-waste. Lithium salts have no power to 
dissolve calculi, but are often of service in alkalizing the urine, 
as well as in increasing its amount and thus rendering it more 
dilute. On the whole, it would appear that their influence is 
somewhat limited, but that as a minor remedy they possess a 
certain amount of usefulness in gouty cases. In diabetes where 
there is a gouty taint remarkably good results have been 
claimed from the use of lithium carbonate or citrate with. 
sodium arsenate. Lithia solutions have been applied exter- 
nally to gouty joints and ulcers, with asserted good results. 
While it is maintained that such applications relieve the pain 
of gouty inflammation and aid the disappearance of deposits, 
they would seem to have no effect in preventing the formation 
of the latter. Gouty conjunctivitis is also said to be relieved 
by washing the eye with a 1 to 500 solution of lithium car- 
bonate. 

Lithium Vanadate closely resembles arsenic in its actions, 
and like arsenic it has been used as an alterative. It has also 
been recommended for the treatment of diabetes, in which it 
is claimed that it reduces the sugar in the urine one-half. 

MAGNESIUM. 

1. MAGNESII SULPHAS.— Magnesium Sulphate. (Epsom Salt.) 
Dose, 16 gm.; 240 gr. 

Preparation. 

Magnesii Sulphas Effervescens.— Effervescent Magnesium 
Sulphate. Dose, 16 gm.; 240 gr. 

2. MAGNESII CARBONAS.— Magnesium Carbonate. Dose, 3 
gm.; 45 gr. 

Preparation. 

Liquor Magnesii Citratis.— Solution of Magnesium Citrate. 
Dose, 360 c.c; 12 fl. oz. 

15 



2IO PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparations. 
Magnesii Citras Effervescens (U. S. P., 1890). — Effervescent 
Magnesium Citrate. Dose, 8 to 30 gm.; y 4 to 1 OZ. 

Mistura Magnesiae et Asafoetidse. — Mixture of Magnesia and 
Asafetida. (Dewees' Carminative.) Dose, 1.20 C.C.; 20 TT\,. 

3. MAGNESII OXIDUM.— Magnesium Oxide. Magnesia. (Light 
Magnesia. Calcined Magnesia.) Dose, 2 gm.| 30 gr. 

4. MAGNESII OXIDUM PONDEROSUM. — Heavy Magnesium 

Oxide. Heavy Magnesia. Dose, 2 gm.; 30 gr. 

Action of Magnesium Salts. 

External. — None. 

Internal. — When injected intravenously, magnesium pro- 
duces much the same effects as potassium, causing paralysis of 
the heart and central nervous system ; but such results are 
never observed when it. is taken by the mouth, as the salts ap- 
pear to be rapidly excreted by the kidneys. Magnesium ox- 
ide and carbonate differ from the other saline cathartics in 
being very insoluble and in having an alkaline reaction, and 
in many ways they act like the alkalies, sodium and potassium. 
In the stomach they are partly converted into magnesium 
chloride, while in the intestine the carbon dioxide present may 
dissolve a part by forming the bicarbonate. They have a mild 
purgative action, and at the same time any excessive acidity in 
the gastro-intestinal tract is overcome by their alkalinity. 
Magnesium sulphate is a much more powerful cathartic. When 
this salt is converted into the bicarbonate in the small intes- 
tine, sodium sulphate is formed, and as the latter is, of course, 
also cathartic, the effect produced is doubly great. Its action 
is as a rule very satisfactory, large watery stools being pro- 
duced, with but little nausea or griping, and on account of 
its non-irritating qualities it will often be retained by the 
stomach when other remedies of its class are rejected. Like 
other alkalies, magnesium oxide and carbonate are diuretic 
and have the effect of promoting the alkalinity of the blood 
and urine, but on account of the difficulty with which they are 



MAGNESIUM. 211 

absorbed, this effect is less pronounced than in the case of 
sodium and potassium salts. The magnesium of the urine is 
increased by the administration of magnesium salts, especially 
if they fail to act on the bowels, but some of the magnesium 
may perhaps be excreted by the intestine and some even ap- 
pear in the milk. In the frog these salts are asserted to paralyze 
the muscles in the same way as potassium, but in mammals 
this is not the case even when they are intravenously injected, 
the animal dying from the action on the heart and central ner- 
vous system before the muscular action is induced. It is a fact 
worthy of note that in some instances the formation of large 
concretions in the bowel, resulting in obstruction, has been 
caused by the prolonged use of considerable amounts of mag- 
nesium oxide. 

Therapeutics of Magnesium Salts. 
Magnesium oxide and carbonate are used as mild antacid 
laxatives. They are favorite remedies in sick headache, espe- 
cially when accompanied by acidity and constipation, and in 
the digestive derangements of children. For the correction of 
acidity the carbonate is preferable if gastric irritability is pres- 
ent, as the carbon dioxide which is set free by the action of 
the acid met with in the stomach serves as a local sedative and 
anodyne. If these preparations do not enter into combination 
with the stomach acid, it is found that no laxative effect is 
produced, and under these circumstances the latter can be 
secured by following their administration with a solution of 
citric acid. In the intestinal indigestion of infants attended 
with flatulent colic magnesia is frequently given in association 
with carminatives, as in the Mistura Magnesise et Asafcetidae 
which was formerly official (Dewees' carminative). On ac- 
count of its antacid property it is also often combined with 
other cathartics. It has been prescribed in lithiasis and gouty 
affections, but in these is much less efficient than other alkalies, 
on account of the small amount of it which is absorbed. In 
order to produce alkaline effects upon the blood and urine it 
should therefore never be given except in cases where the 



212 PHARMACOLOGY AND THERAPEUTICS. 

potassium or sodium salts cannot be borne. Magnesium ox- 
ide and carbonate form insoluble compounds with mineral 
acids, oxalic acid, and the salts of arsenic, copper and mercury, 
while by their alkaline effect on the contents of the stomach 
they retard the absorption of alkaloids. In emergency they 
may therefore be used as antidotes to all these substances, but 
as to secure the desired effect they must be given very freely, 
their bulk makes them objectionable. Magnesia is to be pre- 
ferred, as the carbonate gives off carbon dioxide gas. As an 
antidote to arsenic trioxide in solution it is inferior to ferric 
hydrate, but in the absence of the latter may be resorted to. 
For this purpose it should be freshly precipitated. Magnesium 
sulphate is one of the best and most largely employed of saline 
cathartics. The commonly accepted view is that, like other 
purgatives of its class, it acts by abstracting water from the 
intestinal blood-vessels. It is frequently employed for the 
varieties of constipation associated with hepatic disorder, gout, 
or excessive uric acid, and especially in the form of natural 
mineral waters. It is an important constituent of most of the 
aperient waters. Whenever a thorough purgative action is de- 
sired, it should be given in concentrated form, so as to make 
its solution of as high a percentage as possible, and in cases 
of dropsy from 30 to 60 gm. (1 to 2 oz.) should be taken before 
breakfast, or on an empty stomach, in as little water as will 
dissolve the salt. The efficiency of the drug is greater if the 
amount prescribed is administered in divided doses every fifteen 
minutes until the whole is taken. For habitual constipation in 
those of full habit and active circulation a daily morning dose 
of a teaspoonful is often a permanently effective remedy, and 
where constipation, congestion of the pelvic viscera, and anaemia 
coexist it may be advantageously combined with ferric sul- 
phate, manganese sulphate, and dilute sulphuric acid. The 
disagreeable taste of Epsom salt may be very satisfactorily 
covered by coffee, and the following method of preparation has 
been recommended: Boil for two minutes in an earthen vessel 
30 gm. (1 oz.) of magnesium sulphate and 10 gm. (2 x / 2 dr.) of 



MAGNESIUM. 21 3 

roasted copper in 500 c.c. (1 pint) of water; then remove from 
the fire, allow it to " draw " for a few minutes, and strain. 
Magnesium sulphate may be given by the rectum for the double 
purpose of unloading the bowels and producing a depletant 
effect. It is useful with glycerin in concentrated enema for 
thorough cleansing of the bowels before surgical operations 
(glycerin, 30 c.c; 1 oz., in a saturated solution of magnesium 
sulphate, in hot water, 90 c.c; 3 oz., which is allowed to cool). 
Although theoretically it has been inferred that a saline cathar- 
tic injected intravenously or subcutaneously is incapable of 
causing purgation, practically it is found that a purgative 
action is thus produced; so that magnesium sulphate can also 
be used hypodermatically in dose of 20 gm. (3 gr.), which fre- 
quently will cause a watery evacuation. In operations during 
which the abdomen is opened, the subsequent intestinal paralysis 
may be prevented from causing constipation by injecting into 
the small intestine through a cannula 30 c.c. (one ounce) of a 
saturated solution of magnesium sulphate. The wound in the 
bowel should be closed by a Lembert stitch. 

Being non-irritant, magnesium sulphate may be given freely 
when inflammation is present, and in enteritis and peritonitis it 
is quite commonly used for its depletant action. It is also 
claimed that it' is better than ipecacuanha in the treatment of 
tropical and other dysenteries, and for this purpose is recom- 
mended to be administered in 4 c.c (1 fl. dr.) doses of a satu- 
rated solution with .60 to 1 c.c. (10 to 15 ^l) of aromatic sul- 
phuric acid every two hours. It is especially adapted to the 
acute stage, and morphine sulphate may be combined with it, or 
starch enemata with laudanum employed in addition. In lead- 
poisoning it is also of great service, especially if associated with 
sulphuric acid. Thus combined with sulphuric acid it some- 
times is efficacious in arresting bleeding from piles, especially 
if the state of the haemorrhoidal vessels be due to constipation, 
and it may also serve to relieve uterine haemorrhage caused 
by the presence of a fibroid, or by subinvolution, and conges- 
tion of the pelvic viscera. In impaction of the caecum, with re- 



214 PHARMACOLOGY AND THERAPEUTICS. 

suiting typhlitis, it will often liquefy the faecal masses and de- 
plete the vessels, and thus remove the obstruction without caus- 
ing any irritation. Among other conditions calling for the 
use of an active saline cathartic such as magnesium sulphate 
may be mentioned cholaemia, uraemia, oedema of the brain, and 
increased intra-cranial blood-pressure from whatever cause. 
The citrate is a cooling purgative, which operates mildly. It is 
very widely employed on account of its acceptability to the 
stomach and the facility with which it may be taken, and is 
often especially useful in the case of children. 

CALCIUM. 

1. CRETA PR^EPARATA. — Prepared Chalk. (Drop Chalk.) 
Dose, 1 gm.; 15 gr. 

Preparations. 

1. Pulvis Cretae Compositus. — Compound Chalk Powder. 
Dose, 2 gm.; 30 gr. 

2. Mistura Cretae. — Chalk Mixture. Dose, 16 c.c; 4 fl. dr. 

3. Hydrargyrum Cum Creta.— Mercury with Chalk. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparation. 
Trochisci Cretae (U. S. P., 1890). — Troches of Chalk. Dose, 
ad libitum. 

2. CALCII CARBONAS PR^ECIPITATUS.— Precipitated Calcium 
Carbonate. Dose, 1 gm.; 15 gr. 

Action of Prepared Chalk and Calcium Carbonate. 

External. — Mildly astringent and desiccant. 

Internal. — Calcium carbonate is an antacid, absorbent and 
astringent, though its action in the latter capacity has not yet 
been explained. The great proportion of it taken leaves the 
body in the stools entirely unabsorbed. Such absorption as 
occurs has been found to take place in the upper part of the 
intestine, but the bulk of that which is absorbed appears to be 
re-excreted into the intestine. There is no evidence that it has 



CALCIUM. 215 

any diuretic action. The animal carbonates are said to be less 
liable to derange the stomach than the mineral preparations 
of calcium. 

Therapeutics of Prepared Chalk and Calcium Carbonate. 

External. — Prepared chalk is a good dusting-powder in moist 
eczema, intertrigo and hyperidrosis, and is sometimes used as 
a protective dressing for ulcers and sores. It is largely em- 
ployed, sometimes alone and sometimes with other substances, 
as a dentifrice, because of its mechanical action and also on 
account of its antacid, astringent and sedative effect upon the 
gums and buccal mucous membrane. The following are good 
formulae for tooth-powders : Potassium chlorate, 4 ; powdered 
soap, 8 ; carbolic acid, 2 ; oil of cinnamon, 1 ; precipitated cal- 
cium carbonate to 48 parts. Prepared chalk, 15; powdered 
blue flag flowers, 15; powdered cuttle-fish bone, 8 parts; oil 
of lemon, 1 part. 

Internal. — Chalk mixture is a useful remedy in diarrhoea, 
especially when the intestinal discharges are acid, and opiates 
and astringents are frequently added to it. It should generally 
be preceded by an evacuant to remove undigested food or other 
irritating substances. It is principally employed in the case 
of children. Compound chalk powder and mercury with chalk 
are also used in the treatment of diarrhoea. Calcium carbonate 
is given as a restorative and antacid in acid indigestion. Natural 
mineral waters which contain salts of calcium as prominent 
constituents, such as those of Contrexeville, Wildungen, Vittel, 
Clarendon and Waukesha, have gained considerable reputation 
for the treatment of uric acid gravel and other affections of the 
urinary system ; but it seems probable that the benefit derived 
from them is principally due to the large amount of liquid 
swallowed. They are used in quantities of from 1500 to 3000 
c.c. (3 to 6 pints) a day, and should be taken between meals 
in order to avoid indigestion from the excessive amount of fluid. 

3. CALX. — Lime. Calcium Oxide. (Burned Lime.) 



2l6 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Liquor Calcis. — Lime Water. Solution of Calcium Hy- 
droxide. Dose, 16 c.c; 4 fl. dr. 

2. Linimentum Calcis. — Lime Liniment. (Liniment of Cal- 
cium Oxide.) (Carron Oil.) 

3. Syrupus Calcis. — Syrup of Lime. Syrup of Calcium Hy- 
droxide. (Syrup of Lime.) Dose, 2 c.c; 30 n\. 

Action of Lime. 
External. — Lime water, which is mildly astringent, is also 
slightly caustic, but less so than the syrup. Slaked lime is a 
corrosive and disinfectant. The unslaked lime is changed 
at once to the hydrate in the presence of water, but the hydrate 
differs from those of the caustic alkalies in being much less 
soluble. Hence it does not penetrate so deeply or spread so 
widely. 

Internal. — Lime is antacid and astringent. The reason for 
its astringent action is unknown, but it has been suggested that 
it is probably due to its forming an insoluble compound with 
the surface proteids, in the same way as tannic acid, or to its 
being deposited as the carbonate or phosphate, and thus protect- 
ing the epithelium from irritation. It has the effect of allaying 
vomiting and it causes a subdivision of the coagula formed by 
milk in the stomach. It acts as an antidote to zinc chloride, 
oxalic acid, and mineral acids. The salts of lime are present in 
very large amount in the normal tissues, and it has been demon- 
strated that lime is required by the higher organisms, both 
animals and plants, for some of their functions. 

Therapeutics of Lime. 
External. — As a caustic it is seldom employed alone, but is 
generally combined with caustic potash (forming Vienna paste) 
or with caustic soda to form what is known as London paste. 
Lime water is used as a wash for foul and gangrenous ulcers 
and, either alone or combined with glycerin, in the treatment of 
acute vesicular eczema. It affords marked relief in the pruritus 



CALCIUM. 2 1/ 

which sometimes becomes intolerable in eczema and other in- 
flammatory affections of the skin and the itching experienced 
by the aged. It is also useful as an injection for thread-worms, 
leucorrhcea, gleet, and ulcerations of the bladder, and Lini- 
mentum Calcis is a standard remedy for burns. As the false 
membranes of diphtheria, croup, plastic bronchitis, etc., are com- 
posed largely of mucus, they may be broken down by alkalies, 
and for this purpose lime water is quite commonly employed. 
A lime water spray, produced by the atomizer, may be inhaled 
by the patient, or the patient may inhale the vapors arising 
from lime undergoing the process of slaking with water. 

Internal. — Lime water is very largely used in the treatment 
of vomiting, and for this purpose is generally given with 
milk, in varying proportion. It is constantly added to the 
milk of infants and invalids, as it prevents the formation of 
bulky coagula, and milk thus treated is more easily digested 
and less liable to cause intestinal disturbance. In cases of acid 
poisoning the syrup should be employed, or lime shaken up 
with water (milk of lime), as lime water contains too little 
of the base to be of service. Lime is especially valuable in 
the treatment of oxalic poisoning. As an antacid in the stomach 
it is inferior to many other alkalies, since it tends to delay the 
evacuation of the contents. Lime water and the syrup are 
both used as astringents in diarrhoea, more particularly in 
children, and when the stomach is irritable. In dyspepsia ac- 
companied with vomiting of food a diet exclusively composed 
of lime water and milk is often more effectual than any other 
plan of treatment. Lime water has sometimes been used in 
the treatment of rickets arid bone-softening, but when the fact 
is considered that this contains really less lime than cow's 
milk, it is difficult to see how it can be of any service in such 
conditions. Indeed, the utility of giving lime salts at all in 
rickets has been disputed, as it is contended that the disease 
is not due to a lack of lime in the food nor in the tissues gener- 
ally, but to some abnormal condition which prevents the lime 
salts from being deposited in the bones, although they may be 



2l8 PHARMACOLOGY AND THERAPEUTICS. 

present in abundance in the blood. It has been claimed that 
some improvement has occasionally been observed in cases 
in which the blood seemed less capable of coagulating them 
normally — particularly haemophilia and aneurism — as a result 
of the use of lime, but it has again been contended that the 
deficient coagulability is scarcely likely to be due to lack 
of the lime salts, since much more is taken in the food than is 
sufficient for the organism, and the medicinal lime preparations 
are not more easily absorbed than the combinations present 
in food. The urine of persons who take large quantities of 
lime water is stated to be often alkaline, and sometimes am- 
moniacal. The latter circumstance has been explained as due 
to the presence of calcium carbamate, which readily undergoes 
ammoniacal disintegration. 

4. CALCII PHOSPHAS PR^CIPITATUS.— Precipitated Calcium 
Phosphate. Dose, 1 gm.; 15 gr. 

Preparation. 
Syrupus Calcii Lactophosphatis. — Syrup of Calcium Lacto- 
phosphate. Dose, 8 c.c; 2 fl. dr. 

Action of Calcium Phosphate. 
So far as regards its mass, calcium phosphate is, next to 
water, the most important of the inorganic constituents of the 
body, and in all the solid tissues it is of service by giving to 
them their proper consistence and solidity. Thus, in the enamel 
of the teeth, the hardest tissue of the body, its quantity is no 
less than 885 parts in 1000, while in the bones there are 576 to 
the 1000. The large amount of it required by the system is 
supplied by the food (meats, vegetables, eggs, milk, bread and 
cereals all containing it), and a deficiency of the salt in the 
food leads to softening of the bones. The great proportion 
of the lime taken either in the food or as a remedy is found 
to leave the body in the faeces entirely unabsorbed, while a 
small quantity of it, whether it is taken in a soluble or insoluble 
form, is absorbed from the alimentary canal. This portion 



CALCIUM. 219 

circulates in the blood (in combination with proteids, it is 
thought), and is slowly excreted, unless there is a deficiency in 
the supply of lime, when it may be utilized by the tissues. 
When larger quantities are injected intravenously or subcu- 
taneously, it is stated that the calcium of the blood remains 
abnormally high for some time, but that all the lime thus in- 
jected is not in the circulation throughout its stay in the body; 
some of it being temporarily deposited in some unknown organ, 
from whence it is gradually withdrawn and excreted after 
the first excess is eliminated. The lime is excreted in part in 
the urine, but for the most part through the epithelium of the 
large intestine. 

Therapeutics of Calcium Phosphate. 
Notwithstanding the theoretical objections which have been 
urged against the utility of lime salts in rickets, calcium phos- 
phate has been largely employed in the treatment of this dis- 
ease, and with alleged good results. When used in rickets it 
is important that it should be made from bones. By some pe- 
diatrists the syrup of calcium lactophosphate is given the pref- 
erence, and this preparation is also used to a large extent in 
tuberculosis and other debilitated conditions of the system. 
Pregnant and nursing women are treated with calcium phos- 
phate for the purpose of supplying lime salts for the bones 
of the child. It is frequently combined with other phosphates, 
such as those of iron, sodium and potassium, in the treatment 
of rickets, mollities ossium, the different forms of scrofula, and 
anaemic conditions generally. It has also been thought useful 
in facilitating the union of fractured bones, and in experiments 
upon dogs and rabbits it is asserted that in fractures the callus 
forms more quickly under its use than without it. Being inert 
and almost insoluble, it is sometimes employed as a constituent 
of pills containing essential oils, and as it prevents agglutina- 
tion, is also used as a diluent for powders. 

5. CALCII CHLORIDUM.— Calciuni Chloride. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 



2 20 PHARMACOLOGY AND THERAPEUTICS. 

Action of Calcium Chloride. 
Calcium chloride is an irritant and resolvent. It is ex- 
tremely deliquescent, and its power of absorbing water is 
utilized for the dehydration of alcohol and ether and for other 
purposes. Outside the body it hastens the coagulation of the 
blood and produces a firmer clot. 

Therapeutics of Calcium Chloride. 
On account of its solubility in water calcium chloride is 
readily administered, and it has been employed in the treatment 
of chronic bronchitis, pneumonia, and phthisis and has been 
recommended for gastric catarrh and fermentative dyspepsia. 
Its most important use is for the haemorrhages of scurvy and 
haemophilia; one large daily dose of 2 gm. (30 gr.) is preferable 
to smaller ones frequently repeated. If maximum doses are 
administered for several days previously, it is often possible 
to perform operations upon bleeders. It may be of use in 
haematemesis and haemoptysis, and, possibly, also for aneurism. 
It is said to sometimes cause the resolution of glandular swell- 
ings and the calcification of the cicatrization of tuberculous de- 
posits, and also to be of service in lupus and other skin diseases. 

B. Drugs Acting on the Red Corpuscles. 

IRON. 

1. FERRUM.— Iron. 

2. FERRUM REDUCTUM.— Reduced Iron. (Quevenr.e's Iron. 
Iron by Hydrogen.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

3. FERRI SULPHAS.— Ferrous Sulphate. Dose, 0.200 gm. (200 
milligm.); 3 gr. 

Preparations. 

1. Ferri Sulphas Exsiccatus. — Exsiccated Ferrous Sulphate. 
Dose, 0.125 gr. (125 milligm.) ; 2 gr. 

2. Ferri Sulphas G-ranulatus. — Granulated Ferrous Sulphate. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

3. Mistura Ferri Composita. — Compound Iron Mixture. 
Dose, 16 c.c: 4 fl. dr. 



IRON. 22 1 

4. Pilulse Ferri Carbonatis. — Pills of Ferrous Carbonate. 
(Ferruginous Pills. Chalybeate Pills. Blaud's Pills.) Dose, 2 
pills. 

4. FERRI CARBONAS SACCHARATUS.— Saccharated Ferrous 
Carbonate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

5. MASSA FERRI CARBONATIS.— Mass of Ferrous Carbonate. 
(Vallet's Mass.) Dose, 0.250 gm. (250 milligm.); 4 gr. 

6. SYRUPUS FERRI IODIDL— Syrup of Ferrous Iodide. Dose, 
1 c.c; 15 tt\,. 

7. PILULE FERRI IODIDL— Pills of Ferrous Iodide. Dose, 2 
pills. 

8. FERRI CHLORIDUM.— Ferric Chloride. Dose, 0.065 gm. (65 
milligm.) ; 1 gr. 

9. LIQUOR FERRI CHLORIDL— Solution of Ferric Chloride. 
Dose, 0.1 c.c; V/ 2 n\,. 

Preparations. 

1. Tinctura Ferri Chloridi. — Tincture of Ferric Chloride. 
Dose, 0.5 c.c; 8 1ii. 

2. Liquor Ferri et Ammonii Acetatis. — Solution of Iron and 
Ammonium Acetate. Dose, 16 C.C.; 4 fl. dr. 

10. LIQUOR FERRI TERSULPHATIS.— Solution of Ferric Sul- 
phate. 

11. LIQUOR FERRI SUBSULPHATIS.— Solution of Ferric Sub- 
sulphate. Dose, 0.2 c.c; 3 Til. 

12. FERRI HYDROXIDUM (Ferri Oxidum Hydratum, U. S. P., 
1890). — Ferric Hydroxide. (Hydrated Ferric Oxide.) 

13. FERRI HYDROXIDUM CUM MAGNESII OXIDO (Ferri 
Oxidum Hydratum cum Magnesia, U. S. P., 1890). — Ferric Hydroxide 
with Magnesium Oxide. Dose (arsenical antidote), 120 C.C.; 4 fl. OZ. 

14. FERRI ET AMMONII SULPHAS.— Ferric Ammonium Sul- 
phate. (Ammonio-Ferric Alum.) Dose, 0.500 gm. ' (500 milligm.) ; 
IV2 gr. 

15. FERRI PHOSPHAS SOLUBILIS.— Soluble Ferric Phosphate. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 



22 2 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Syrupus Ferri, Quininae et Strychninae Phosphatum.— 

Syrup of Iron, Quinine and Strychnine Phosphates. (Easton's 
Syrup. Syrupus Trium Phosphatum.) Dose, 4 gm.; 1 fl. dr. 

2. Elixir Ferri, Quininae et Strychninae Phosphatum. — 

Elixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c.; 1 fl. dr. 

3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. 

- — Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 

1 c.c; 15 ul. 

16. FERRI ET AMMONII TARTRAS.— Iron and Ammonium 
Tartrate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

17. FERRI ET POTASSII TARTRAS.— Iron and Potassium Tar- 
trate. (Tartarated Iron.) Dose, 0.250 gm. (250 milligm.); 4 gr. 

18. FERRI CITRAS.— Ferric Citrate. Dose, 0.250 gm. (250 mil- 
ligm.) ; 4 gr. 

19. FERRI ET AMMONII CITRAS.— Iron and Ammonium Citrate. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

Preparation. 
Vinum Ferri (Vinum Ferri Citratis, U. S. P., 1890). — Wine 
of Iron. (Wine of Ferric Citrate.) Dose, 8 C.C.; 2 fl. dr. 

20. FERRI ET QUININE CITRAS.— Iron and Quinine Citrate. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

Preparation. 
Vinum Ferri Amarum.— Bitter Wine of Iron. Dose, 8 c.c; 

2 fl. dr. 

21. FERRI ET QUININE CITRAS SOLUBILIS.— Soluble Iron 
and Quinine Citrate. Dose, 0.250 gm. (250 milligm.); 4 gr. 

22. FERRI ET STRYCHNINE CITRAS.— Iron and Strychnine 
Citrate. Dose, 0.125 gm. (125 milligm.); 2 gr. 

23. FERRI PYROPHOSPHAS SOLUBILIS.— Soluble Ferric Pyro- 
phosphate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

24. FERRI HYPOPHOSPHIS. — Ferric Hypophosphite. Dose, 
0.200 gm. (200 milligm.); 3 gr. 



IRON. 22 3 

Preparation. 
Syrupus Hypophosphitum Compositus. — Compound Syrup of 
Hypophosphites. Dose, 8 C.C.; 2 fl. dr. 

Unofficial Preparations. 
Syrupus Hypophosphitum cum Ferro (U. S. P., 1890). — Syrup 
of Hypophosphites with Iron. Dose, i to 8 C.C.; 1 to 2 fl. dr. 

Ferri Iodidum Saccharatum (U. S. P... 1890). — Saccharated 
Ferrous Iodide. Dose, 0.30 to 1 gm.; 5 to 15 gr. 

Ferri Lactas (U. S. P., 1890). — Ferrous Lactate. Dose, 0.06 
to 0.30 gm.; 1 to 5 gr. 

Liquor Ferri Nitratis (U. S. P., 1890). — Solution of Ferric 
Nitrate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT[. 

Liquor Ferri Citratis (U. S. P., 1890). — Solution of Ferric 
Citrate. Dose, 0.30 to 1 c.c; 5 to 15 TT1 . 

Liquor Ferri Acetatis (U. S. P., 1890). — Solution of Ferric 
Acetate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT\. 

Emplastrum Ferri (U. S. P., 1890). — Iron Plaster. (Strength- 
ening Plaster.) 

Trochisci Ferri (U. S. P., 1890). — Troches of Iron. Dose, 
1 to 2 troches. 

Ferri Valerianas (U. S. P. ; 1890). — Ferric Valerianate. Dose, 
0.06 to 0.20 gm.; 1 to 3 gr. 

Ferri Arsenas. — Iron Arsenate. Dose, 0.005 to 0.008 gm.; 
T V to Vs gr. 

Ferrum Dialysatum. — Dialyzed Iron. Dose, 0.30 to 2 c.c; 

5 to 30 TTl. 

Ferratinum. — Ferratin. Dose, 0.10 to 0.50 gm.; V/ 2 to 8 gr. 

Action of Iron and its Salts. 
External. — While the salts of iron and their solutions have 
no action on the unbroken skin, on the abraded cuticle and on 
mucous membrane they have a powerful astringent effect by 
reason of their property of precipitating proteids ; so that all 
albuminous fluids are coagulated by them. In consequence 



224 PHARMACOLOGY AND THERAPEUTICS. 

of this action on the blood, as well as their effect on the vessels 
themselves, by which the calibre of the latter is diminished 
by the contraction of the coagulated albumin, they tend to arrest 
haemorrhage, and constitute in fact the most efficient local 
haemostatics at our command. While, however, some of the 
iron salts, such as the chloride, the nitrate, and the sulphate, 
have very marked astringent value, others are practically inert 
in this respect. Solutions of both ferrous and ferric salts have 
more or less antiseptic, germicidal and disinfectant activity, 
and since, in addition to arresting putrefaction, they neutralize 
the sulphur and ammonium compounds given off from decay- 
ing matter, they are also deodorizers. Ferric oxides, further- 
more, have the power of converting oxygen into ozone. 

Internal. Mouth. — Most of the preparations of iron have 
a peculiar metallic and astringent taste, known as chalybeate, 
which is most pronounced in the case of the persalts. The in- 
soluble and albuminous ones should be practically tasteless. 
The blackening of the teeth and tongue which is liable to result 
from the use of iron preparations has been supposed to be due 
to the formation of iron tannate from the tannic acid of the 
food or from the sulphur present in carious teeth or in the tar- 
tar. To avoid this it is advisable to take them through a glass 
tube and immediately afterwards to brush the teeth. The free 
acid in the tincture of ferric chloride or the acidity of the 
chloride itself will destroy the dental enamel even if diluted 
with eight parts of water. 

G astro -intestinal Tract. — In the stomach almost all the iron 
salts, it is supposed, form chlorides to a greater or less ex- 
tent, and are then changed into albuminates. Ferric chloride 
is said to be the only one of them which does not abstract 
hydrochloric acid from the gastric juice, and it is believed that 
it is probably to this circumstance that its peculiar value as 
a chalybeate remedy is due. Inorganic salts, if taken in suffi- 
cient quantity, act as gastro-intestinal irritants, causing pain 
and discomfort, with nausea and vomiting, and sometimes purg- 
ing. The more strongly acid ones have a more or less marked 



IRON. 225 

caustic effect upon the stomach, in consequence of the acid 
liberated after the formation of chlorides, and this is the -case 
even with preparations of ferric chloride, which always con- 
tain free acid. Hence those preparations which are not at all 
or but slightly acid, such as reduced iron, ferrous carbonate, 
and the unofficial dialyzed iron, do not as a rule cause digestive 
trouble, though it can also be said that they are generally not 
so efficient as the stronger preparations. However, this free 
acid may be neutralized by the addition of sodium bicarbonate, 
so that the tincture of ferric chloride will be acid only so far 
as the basic ferric chloride has an acid reaction; nor does 
this neutralization impair its therapeutic properties, for hydro- 
chloric acid is added to it in the stomach. An effective prep- 
aration is now made, in which these disadvantages of the tinc- 
ture of ferric chloride are removed, which is known as Weld's 
syrup of ferric chloride. As ferric chloride is strongly astrin- 
gent, most iron salts have an astringent action on the stomach, 
the degree of astringency depending upon the amount of the 
chloride which is formed from the gastric juice or is otherwise 
present. In the duodenum it is believed that the iron com- 
pounds, having been changed from chlorides into albuminates 
in the stomach, may in part be absorbed in solution, or precipi- 
tated and taken up as solids by the epithelial cells and the leuco- 
cytes, while the great bulk is carried on into the lower parts of 
the intestine. Under medicinal doses the secretions of the ali- 
mentary canal show a tendency to diminish, with the produc- 
tion of constipation, with hard, dry stools, while the faeces are 
blackened from the formation of ferrous sulphide and tannate. 
Absorption and Excretion. — The absorption of iron has been 
the subject of much discussion, but it seems to be now well 
established that inorganic iron salts, as well as the organic, 
are absorbed by the intestine. While authorities differ as to 
whether organic iron given by the mouth increases the amount 
of iron in the urine or not, the preponderance of evidence is 
to the effect that the quantity which is normally excreted in 
the urine (0.5 to 1.5 mg.) is not affected by the internal admin- 
16 



226 PHARMACOLOGY AND THERAPEUTICS. 

istration of either the organic or inorganic preparations. Hence 
the fact that an iron salt given by the mouth does not increase 
the urinary iron affords no ground for the assumption that it 
has not been absorbed. Neither does the iron absorbed increase 
the amount of iron in the bile or other excretions. The latest 
results of experimental researches would seem to indicate that 
the small part of the iron which in the duodenum is absorbed 
by the epithelium and leucocytes passes through the lymph 
channels to the mesenteric glands, and thence through the 
thoracic duct to the blood-vessels. It is then deposited in the 
spleen, where it may undergo some changes in form; later it 
is taken up by the blood and deposited in the liver and perhaps 
in the bone marrow. Where the supply of iron has been inade- 
quate for the formation of haemoglobin, it is thought that the 
originally inorganic iron is probably worked into higher forms, 
and eventually into haemoglobin in the liver, and that ferratin 
(which is an iron-containing proteid) is one of the intermediate 
steps in this synthesis. When there is no such deficiency, 
however, the liver slowly yields its store of iron to the blood, 
which carries it to the caecum and large intestine, by the epi- 
thelium of which it is finally excreted. Iron is normally present 
in all the tissues and secretions, but the greater portion of the 
total quantity in the body (estimated to be about 2.5 to 3.5 gm. ; 
40 to 55 gr., in a healthy adult), is to be found in the blood as 
haemoglobin. While some .0054 to .0108 gm. ( T ^ to i- gr.) of 
iron is taken in the food per diem, about the same amount is 
excreted, chiefly in the faeces and to a much smaller extent in 
the urine. Any excess of elimination following subcutaneous 
injection or excessive absorption from the intestine, it may 
be noted, takes place through the intestinal mucous membrane. 
Blood. — It is very much open to question whether an increase 
in the number of red blood-corpuscles or any other especial effect 
on the blood, is caused by the administration of iron in health. 
In many cases of anaemia, however, and particularly of chlorosis, 
the remedy has the effect of rapidly increasing both the num- 
ber of these corpuscles and the amount of haemoglobin in the 



IRON. 227 

blood. Iron is therefore said to be a haematinic, and as an 
improvement in the quality of the blood results in an improve- 
ment in the functions of the various organs of the body, it is 
also regarded as a tonic. Although the latest investigations 
show that inorganic iron follows the same course in the tissues 
as food iron, in the treatment of anaemic conditions it may some- 
times have a much more satisfactory effect than the latter. 
Thus, it has been pointed out that food-iron is always accom- 
panied by a large amount of colloid material, which may ma- 
terially delay its absorption, in particular as it seems absorb- 
able in only a very small part of the alimentary tract, the 
duodenum; inorganic iron on the other hand is much less 
completely enveloped and may be more easily absorbed. More- 
over, the iron preparations are used in much larger amounts 
than the food-irons, since to obtain the same effect from the 
latter it would be necessary to give more of them than could 
be digested. Accordingly, certain cases of chlorosis are met 
with in which little or no improvement seems to result from 
the use of foods containing iron, but which recover rapidly 
under inorganic iron. 

General Symptoms. — The general effects of iron upon the 
system, it has been found, can be obtained only by the intra- 
venous injection of double salts, like sodio-ferric tartrate, which 
do not coagulate the blood and at the same time are capable of 
freeing the iron ion in the tissues. From the results of ex- 
perimentation it would appear that iron, like the other heavy 
metals, has a specific irritant effect on the gastro-intestinal 
mucous membrane, and to a less extent on the kidney. It also 
depresses and eventually paralyzes the central nervous system, 
though how far this is the result of direct action and how far 
it is secondary to its effects in the alimentary canal is as yet 
unknown. The heart is apparently but little affected, though 
towards the end a rapid fall of blood-pressure is noticed. 
Post-mortem there is found swelling and congestion of the 
mucous membrane of the stomach and intestine, with numerous 
small blood extravasations in many instances. 



228 PHARMACOLOGY AND THERAPEUTICS. 

Remote Effects. — In addition to the improvement of the gen- 
eral system in anaemic subjects derived from the continued ad- 
ministration of iron, it has been thought that this agent has a 
direct effect on the kidneys (as a mild diuretic), as well as 
upon the menstrual function. More oxygen is carried to all the 
tissues, however, and it is possible that these supposed specific 
effects, which are not of a marked character, are simply the 
result of the benefit from the remedy in which the whole body 
shares. That the iron salts should have any remote astringent 
or haemostatic action, as has been contended by some, has never 
been demonstrated, and on theoretical grounds would seem to 
be highly improbable. Indeed, it is held by high authorities 
that to give iron in cases of metrorrhagia or menorrhagia is 
only to increase the loss of blood. The continued use of 
ferruginous preparations is liable to interfere with the diges- 
tion, and may produce gastric oppression, and even nausea and 
vomiting. In addition, they may give rise to acne, and in rare 
instances to symptoms of plethora and vascular excitement, 
with possibly haemorrhages from the mucous membranes. Ex- 
ceptionally also they may induce irritation of the kidneys, 
while in gouty subjects iron is apt to be badly borne. In gen- 
eral, the ferrous salts are likely to produce less disturbance in 
the system than the ferric ones, and the preparations which are 
best tolerated are reduced iron, the phosphate, and the pyro- 
phosphate. 

Therapeutics of Iron and its Salts. 
External. — Liquor Ferri Subsulphatis (Monsel's solution) and 
solutions of the sulphate, chloride and nitrate have long been 
held in the highest repute as local haemostatics, and are usually 
employed on lint or cotton, the special method of application 
depending on the part where the haemorrhage occurs. These 
preparations, however, form very disagreeable clots, which 
readily decompose and give rise to septic infection. The 
astringent salts of iron are not to be recommended in either 
superficial or deep wounds, where the haemorrhage can usually 



IRON. 229 

be controlled with more satisfactory results by properly ap- 
plied pressure. As an astringent for painting on the parts in 
pharyngitis or tonsillitis Liquor Ferri Chloridi, diluted with 
an equal quantity of water, is of service, or a solution of 1 
part of ferric chloride in 4 of glycerin may be used. The 
aqueous .solution of the chloride has also been employed as a 
spray for haemoptysis, but is objectionable for this purpose, as 
it is very liable to excite coughing. The tincture of ferric 
chloride has been highly recommended as a local application 
to the throat in diphtheria, and in erysipelas is sometimes painted 
over the inflamed surface. A wash containing .12 to .3 gm. (2 
to 5 gr.) of the sulphate to 30 c.c. (1 fl. oz.) of water is often 
useful in chronic and indolent ulcers, and a solution of the sul- 
phate (1 to 480) has also been used in gleet. 

Internal. Gastro-intestinal Tract. — In haemorrhage of the 
stomach, from whatever cause, the astringent preparations may 
often be employed with advantage. If the bleeding is profuse, 
4 c.c. (1 fl. dr.) of Liquor Ferri Chloridi, with 4 c.c. (1 fl. dr.) 
of glycerin to facilitate swallowing, should be given every hour 
or oftener; but such large quantities are not required in milder 
cases. Intestinal haemorrhage may also be treated in the same 
way, though the success of the remedy will depend largely on 
the location of the trouble. 

It is a common practice to counteract the tendency of the 
salts of iron to cause constipation by combining purgatives 
with them, but this method interferes with the time during 
which iron remains in the intestines, and it is better to admin- 
ister the laxative separately, so that the dose can be regulated 
according to circumstances. A pill of ferrous sulphate and ex- 
tract of nux vomica is often found very effectual in the treat- 
ment of chronic constipation. Here the active agent would 
seem to be the nux vomica, although it has been claimed by 
some that such constipation may be overcome by large doses 
of ferrous sulphate alone. At least, the constipating effect of 
iron salts is no doubt often much exaggerated. They have 
sometimes been given for diarrhoea, but this can be more satis- 
factorily treated by many other drugs. 



23O PHARMACOLOGY AND THERAPEUTICS. 

Thread- worms may be killed by a rectal injection of 4 c.c. 
(1 fl. dr.) of the tincture of ferric chloride in 250 c.c. (half a 
pint) of water, with the patient in the knee-chest position. 

One of the most efficient means of treating arsenical poison- 
ing is by ferric hydroxide with magnesium oxide. To prepare 
this for use a mixture of magnesium oxide (10 gm.) with 
sufficient water to make a homogeneous, thin magma is added 
gradually to solution of ferric sulphate, 40 c.c, mixed with 125 
c.c. of water, and the product is then shaken until a uniform, 
smooth mixture results. For the rapid preparation of this 
antidote it is advised that the diluted solution of ferric sulphate 
and the mixture of magnesium oxide with water should always 
be kept in readiness, in separate bottles. It should be given in 
large doses and frequently repeated. Another arsenical anti- 
dote is prepared by mixing together 90 c.c. (3 fl. oz.) of solu- 
tion of ferric sulphate and 30 gm. (1 oz.) of sodium car- 
bonate diluted with water, and of this, 15 c.c. ( z / 2 fl. oz.) should 
be given at short intervals. The insoluble arsenite which is 
formed in the body may be gotten rid of by a large dose of 
some simple purgative, such as magnesium sulphate. Poison- 
ing by arsenic may be also successfully treated by a dose of 
common salt or of sodium bicarbonate, followed by 30 c.c. (1 
fl. oz.) of dialyzed iron (which is useless as an iron prepara- 
tion), diluted with water. 

Ferruginous preparations are often administered with ad- 
vantage for the purpose of improving the appetite and digestion, 
and it is held by some that the chief use of iron as a remedy, 
even in anaemia, is to promote the digestive function. To aid 
appetite and digestion ferrous sulphate will usually be found 
the most serviceable preparation. 

Blood. — As has been stated, the administration of iron in 
anaemia, and especially chlorosis, often rapidly increases the 
amount of haemoglobin and the number of red corpuscles; and 
it is to restore these to their normal quantity that the ferrugi- 
nous preparations are most commonly given. It is to be noted, 
however, that they are useless in pernicious anaemia and of little 



IRON. 23 1 

value, if any, in the anaemia of leukaemia, exophthalmic goitre, 
and Hodgkin's disease. In common forms of anaemia which 
are secondary to some special cause, such as haemorrhage, lead 
poisoning, malaria, scurvy, etc., the removal of the cause is 
essential to recovery, but the use of iron salts is often of great 
service in aiding the latter. It has frequently been observed 
that iron has very little, if any, beneficial effect upon anaemic 
patients when it does not increase the desire for food and the 
ability to digest it, and in the anaemic condition, therefore, 
ferruginous preparations should be given not only for the 
purpose of restoring the quantity of the elements in which the 
blood is deficient, but also to increase the energy of the primary 
assimilation. To secure the latter object increasing quantities 
of the more active astringent salts, especially the sulphate and 
the chloride, are best. Large doses of these are frequently 
well borne, though it is worth noting that considerable amounts 
of the sulphate have been known to occasion obstruction of 
the bowels. When they produce any untoward effects they 
should be replaced by other preparations, preference being 
given to the most astringent ones which will be tolerated by 
the stomach. The styptic taste of the astringent compounds 
may be concealed by administering them with 4 c.c. (1 fl. dr.) 
of glycerin, which also has the effect of reducing some of the 
ferric to a ferrous salt, and this substance is frequently added 
to the tincture of ferric chloride. To restore the amount of 
haemoglobin and the number of red corpuscles, small doses — .06 
to .12 gm. (1 to 2 gr.) — of reduced iron or of the carbonate, 
or some one of the combinations with vegetable acids, are 
usually the most serviceable. As the scale preparations rarely 
disagree, they are much used for patients with weak digestion, 
and small doses can generally be continued for an indefinite 
period. The red wines and natural chalybeate waters, such 
as those of La Bourboule, Levico, Flitwick and the Columbian 
spring, Saratoga, may also prove useful. The numerous other 
symptoms besides dyspepsia which are dependent upon anaemic 
conditions, such as constipation, neuralgia, amenorrhcea, etc., 



232 PHARMACOLOGY AND THERAPEUTICS. 

are naturally improved by the treatment of the anaemia with 
iron. In chlorosis better results are often obtained from com- 
binations of iron with strychnine or arsenic than from iron 
alone. Easton's syrup (Syrupus Ferri, Quininae et Strychninae 
Phosphatum) and Easton's pill (Pilula Trium Phosphatum), 
which consists of quinine, .06 gm. (1 gr.) ; strychnine, .002 gm. 
(ti & r > concentrated phosphoric acid, .10 c.c (i l / 2 HI) ; and 
liquorice powder to .30 gm. (5 gr.) are much employed in con- 
valescence after serious illness and in anaemia and chlorosis gen- 
erally. Iron arsenate, although not official, is an excellent 
remedy in chlorosis. Good results have sometimes been claimed 
from ferrous iodide in cases of rheumatoid arthritis, and this 
preparation is very largely used for rachitic and scrofulous 
children, especially in association with codliver oil. The tinc- 
ture of ferric chloride, in doses of .60 to 1.20 c.c. (10 to 20 HI), 
sometimes as often as every hour, has proved beneficial in 
diphtheria and other severe diseases affecting the throat, and 
this is a favorite remedy in erysipelas. As the administration 
of iron tends to elevate the temperature in the sick, however, 
ferruginous preparations are generally inadvisable in other 
febrile diseases. Some individuals cannot take iron at all, on 
account of the severe headache or indigestion which it in- 
duces. Iron should always be administered when the stomach 
is full (after meals), except when given for follicular ton- 
silitis, diphtheria, erysipelas, gastric haemorrhage, or arsenical 
poisoning. 

Kidneys. — It would seem that iron probably has some specific 
action on the kidney, though its diuretic effect is comparatively 
slight. In Bright's disease the tincture of ferric chloride is 
constantly resorted to, both for its tonic and diuretic properties. 
Liquor Ferri et Ammonii Acetatis (Basham's mixture), an 
elegant preparation which is useful as a diaphoretic as well 
as a diuretic, has long been a favorite prescription in the 
anaemia of both acute and chronic parenchymatous nephritis. 

The Different Preparations of Iron. — While many of these 
are quite strongly astringent, others are practically non- 



IRON. 233 

astringent. There are some, viz., the iodide, the arsenate, the 
phosphate, iron and quinine citrate, and iron and strychnine 
citrate, in which the drugs with which the iron is com- 
bined increase their value and give them special applica- 
tions. While it has been thought that the arsenate must be 
exhibited in such small doses, in order to avoid arsenical poison- 
ing, that the iron in it can have little or no effect, clinicians 
have found that practically this preparation is by no means so 
actively toxic as is generally supposed, and that in compara- 
tively large doses it is an excellent remedy, particularly in 
chlorosis. In any case where arsenic is indicated in which 
such doses are not well borne, it is better to administer the 
two drugs separately. Ferric phosphate, which always con- 
tains some free phosphoric acid, is a reliable hsematinic, and 
it is a very palatable preparation. It has been largely used for 
children, and especially in rickets, under the idea that the 
phosphorus in it would promote the growth of bones. Parish's 
food, known also as Squire's chemical food, and Dusart's syrup 
both have for their chief ingredient ferric phosphate; the dose 
of each is 2 to 8 c.c. ; y 2 to 2 fl. dr. While in ferrous iodide 
the proportion of iron to iodine is small (1 to 9), it is a very 
useful preparation, although it is especially liable to injure the 
teeth. The iron and quinine citrate is a favorite mild prepara- 
tion for slight cases of anaemia, but must not be prescribed 
with alkalies, as they precipitate the quinine. Ferratin (not 
official) is claimed to be the characteristic iron compound of 
the liver. It is an acid albuminate, prepared artificially, and 
is used in doses from i l / 2 gr. ; .10 gm. to 8 gr. ; .50 gm. No 
evidence, experimental or clinical, has as yet been brought 
forward, which, outside of theoretical reasoning, makes the 
superiority of this over the older iron compounds probable. 
Since it is practically tasteless it is easily administered. Prac- 
tically all of the albuminates and peptonates to be found in the 
shops are worthless as hsematinics. 



234 PHARMACOLOGY AND THERAPEUTICS. 

ARSENIC. 

1. ARSENI TRIOXIDUM (Acidum Arsenosum, U. S. P., 1890).— 
Arsenic Trioxide. (Arsenous Acid. White Arsenic.) Dose, 0.002 
gm. (2 milligm.) ; ^ gr. 

Preparations. 

1. Liquor Potassii Arsenitis. — Solution of Potassium Arsen- 
ite. (Fowler's Solution.) Dose, 0.2 C.C.; 3 TT\,. 

2. Liquor Acidi Arsenosi. — Solution of Arsenous Acid. Dose, 
0.2 c.c; 3 nl. 

2. SODII ARSENAS.— Sodium Arsenate. Dose, 0.005 gm. (5 mil- 
ligm.) ; T \ gr. 

3. SODII ARSENAS EXSICCATUS.— Exsiccated Sodium Arsen- 
ate. Dose, 0.003 gm. (3 milligm.) ; ^\ gr. 

Preparation. 
Liquor Sodii Arsenatis. — Solution of Sodium Arsenate. 
(Pearson's Solution.) Dose, 0.2 c.c; 3 Tit- 

4. ARSENI IODIDUM.— Arsenous Iodide. Dose, 0.005 gm. (5 mil- 
ligm.) ; T \ gr. 

Preparation. 
Liquor .Arseni et Hydrargyri Iodidi. — Solution of Arsenous 
and Mercuric Iodides. (Donovan's Solution.) Dose, 0.1 C.C.; 

1% ni. 

Unofficial Preparations. 
Oleatum Arseni. — Oleate of Arsenic. 

Unguentum Arseni Oleati. — Ointment of Oleate of Arsenic. 
Acidum Cacodylicum. — Cacodylic Acid. Dose, .24 gm.; 4 gr. 

Ferri Arsenas. — Iron Arsenate. Dose, 0.005 gm. to 0.008 
gm.; T \ to y 8 gr. 

Sodii Cacodylas.— Sodium Cacodylate. Dose, .05 to .15 gm.; 
% to 2y 2 gl"., hypodermatically. 

Action of Arsenical Compounds. 
External. — Arsenic trioxide has no effect on the unbroken 
skin, unless it is repeatedly applied or allowed to remain in con- 






ARSENIC. 235 

tact with it for some time, when it may occasion redness or erup- 
tions of various kinds. Upon denuded surfaces and mucous 
membrane it has a considerable though slow caustic action. It 
acts much more energetically upon the higher than upon the 
lower organisms, and is not therefore of value as a germicide. 
While arsenic is toxic to all animals having a central nervous 
system and to most of the higher plants, it is not so to all 
lower organisms, and hence cannot be regarded as a general 
protoplasmic poison. It has the property of preserving animal 
tissues almost indefinitely. When metallic arsenic in a state 
of fine division is rubbed into the skin some toxic symptoms are 
observed which are thought to be due to its absorption in the 
form of an oxide. 

Internal. Alimentary Canal. — Toxic doses of arsenical prep- 
arations produce an acute gastro- enteritis. How far this is 
due to local action is now considered somewhat uncertain. As 
has been stated, the caustic action occurs but slowly, and the 
post-mortem findings show that the corrosion is seldom ex- 
tensive. Moreover, it has been found that the gastro-enteritis 
may be obtained with equal facility by injecting arsenic into 
the circulation. From the fact that under these circumstances 
some arsenic is excreted into the alimentary canal there may no 
doubt be some local action, but it is held that the quantity thus 
excreted is quite insufficient to account for the symptoms. 
Still further, it is known that arsenical compounds do not, like 
the corrosive poisons, change proteids in solution. The action 
of arsenic on the alimentary canal cannot therefore be re- 
garded as due to any ordinary form of corrosion. No matter 
how it is introduced into the system, the first and most marked 
effects are observed in the intestine. In consequence of the 
capillary paralysis produced by the drug there results an exuda- 
tion, which, having caused the throwing off of the epithelium 
in shreds, is poured out into the gut, where it becomes in great 
part coagulated. The epithelial coat of the intestine is found 
to have undergone fatty degeneration, and the degenerated 
epithelium sometimes closely resembles false membrane. The 



236 PHARMACOLOGY AND THERAPEUTICS. 

effect of this action is to set up a diarrhoea with stools having a 
"rice water" appearance, due to the shreds of mucous membrane 
and coagulated exudation which characterize them. Attention 
has been called to the fact that the pathology of this condition is 
exactly the same as that of Asiatic cholera, so that without 
a history it is impossible to distinguish between the two ex- 
cept by chemical examination of the dejecta. In exceptional 
instances the dilatation of the capillaries caused is so extreme 
that they become ruptured, and there result ecchymoses upon 
the mucous membrane, or even haemorrhage into the intestine 
or stomach, with bloody stools or vomiting. In therapeutic 
doses arsenic acts as a gastric stimulant, the dilatation of the 
vessels causing an increased flow of gastric juice; and in the 
same way the secretions of the duodenum are stimulated. It 
both increases the appetite and promotes digestion, and its 
specific action on the epithelium is no doubt concerned in the 
production of this effect. 

Blood-vessels and Circulation. — Mention has been made of 
the paralysis of the capillary vessels produced by arsenic. It 
is now believed by many that this capillary paralysis explains 
the whole course of the toxic action of the drug; the phenomena 
noted resembling those produced by an irritant inflammation, 
one of the essential features of which is increased permeability 
of the capillaries. In arsenical poisoning there is an early 
and pronounced fall of blood-pressure, and this has been demon- 
strated to be almost entirely vascular in origin. The vascular 
paralysis occasioned is mainly peripheral, and as the arterioles 
are found to be still capable of contracting, it is assumed that 
the structures beyond them, namely the capillaries, which more- 
over, are known to have become more permeable, are the seat 
of the paralysis. In addition, however, arsenic has some direct 
action upon the heart, paralyzing its rhythmic power and also 
depressing its contractility. In the excised heart of the frog 
the rapidity and force of the heart are diminished till the organ 
finally stops. Some of the most recent investigators, in ac- 
counting for the fall of blood-pressure, explain that the vaso- 



ARSENIC. 237 

motor centre and later the splanchnic nerves lose their control 
over the vessels. The dilatation of the mesenteric vessels leads 
to very marked congestion of the stomach and intestine, and, 
along with the lessened efficiency of the heart, reduces the 
pressure to zero. It would seem, therefore, that arsenic is 
poisonous chiefly from its depressant action on the vessels of 
the splanchnic area. 

Blood. — Opinions differ somewhat as to the action of arsenic 
on the blood. Some observers have found that in the normal 
subject it diminishes the number of the red corpuscles, but does 
not alter the total haemoglobin of the blood. Others find the 
blood-cells and haemoglobin unaltered by arsenic in normal 
animals, but describe the bone-marrow as evidently in a state 
of unusual activity, indicated by its increased vascularity, 
greater number of red corpuscles, and lessened fat-cells. In a 
case of pernicious anaemia recently examined it was noted that 
arsenic increased the number of newly formed red corpuscles, 
but that the number of more mature ones was diminished. 
While the action of arsenic is still obscure, it may be stated 
that the amount of haemoglobin does not seem to be affected by 
it, and that in certain diseases in which deficiency of the red 
corpuscles is a prominent symptom its administration is known 
to be capable of increasing their number, while in chlorosis and 
in health it apparently does not do so. In conditions of general 
poor health any improvement in the blood under its use has by 
many been attributed to improved appetite and increased nutri- 
tional activity. 

Respiration. — The respiration is temporarily accelerated by 
the intravenous injection of arsenic. In cases of poisoning in 
man it is only late that it is seriously affected, but it ceases 
before the heart. The failure of respiration is thought to be 
due to exhaustion and low blood-pressure, rather than to any 
specific action on the respiratory centre. 

Nervous System. — In frogs arsenic produces a descending 
paralysis, and it is recognized that in them the brain, spinal 
cord, and nerve terminations are directly acted on by it. In 



238 PHARMACOLOGY AND THERAPEUTICS. 

mammals, however, there is no evidence of such direct action 
in acute poisoning, though in chronic poisoning, as well as after 
a single large but not immediately fatal dose, lesions have 
sometimes been observed either in the spinal cord or the peri- 
pheral nerves. 

Absorption and Excretion. — Arsenic is taken into the blood 
with great facility, and that absorption may take place even 
from the unbroken skin is shown by the fact that cases of 
poisoning occur from the use of cosmetic preparations contain- 
ing the drug. It is excreted in the urine, faeces, sweat, and all 
the other excretions, though chiefly by the kidney, and the 
process is a very slow one. It is stored in all the organs ; some 
authorities stating that it is found, after absorption, in largest 
quantity in the liver, while others deny this. By means of the 
placental circulation it may also pass from the mother to the 
foetus. A minute amount of arsenic is normally present in the 
thyroid and thymus glands, the brain, and the skin in man, but 
none is found in the liver. Owing to its more intense action 
on the alimentary canal, the effect of arsenic on metabolism is 
not so liable to be noted as in the case of phosphorus, but it 
is very much the same. While the nitrogen of the urine is 
considerably increased, it is somewhat uncertain whether this 
is to be attributed to an increase in the urea or of other nitrog- 
enous substances. The ammonia seems to be increased, while 
the glycogen of the liver disappears entirely, and the liver is 
apparently incapable of forming it from the sugar of the food. 
The fatty degeneration which characterizes its action on the 
gastric and intestinal epithelium is also found in the liver and 
kidney, the muscle-cells of the heart, the blood-vessels and 
striated muscles, and the lining membrane of the alveoli of the 
lungs. While arsenic, like phosphorus, lessens the oxidation 
of the tissues and causes fatty degeneration of the cells of 
various organs, it seems probable that it may also increase the 
waste of the proteids of the body directly, though the increase 
in the nitrogen of the urine may possibly be secondary to the 
other features. The fatty degeneration which occurs may have 






ARSENIC. 239 

the same results as in phosphorus poisoning. The liver is found 
to be somewhat enlarged, while the pressure on the bile ducts 
prevents the escape of bile into the intestine. Jaundice, how- 
ever, is but rarely a very marked feature of arsenical poison- 
ing, and may be entirely absent. The improvement in nutrition 
under arsenic in doses insufficient to induce chronic poisoning 
is not well understood, though it may be that more of the food 
is utilized by the digestive apparatus, while at the same time 
less proteid is decomposed by the tissues. While it cannot be 
regarded at present that the effects of arsenic on the nutrition 
are definitely established, it is a recognized fact that as long 
as the drug does not interfere with digestion and absorption, 
it increases the excretion of nitrogen. Under these circum- 
stances it also causes increased deposition of fat. In the moun- 
tainous districts of Styria many of the inhabitants regularly 
eat white arsenic with the result of an increase in appetite, 
weight and strength and an improvement in the complexion. 
They gradually accustom themselves to use quantities which 
would prove fatal to ordinary individuals, and this tolerance 
seems the more remarkable as it has never been found possible 
to secure such an acquired immunity in the case of animals. It 
has been suggested that an antitoxin may be developed in these 
people. Usually, it is said, large doses are taken by them once 
or twice a week, and no fluid is swallowed for some time after- 
wards, so that some of the poison may pass through the bowel 
unabsorbed. These Styrian peasants generally live to old age, 
and no toxic symptoms are observed in them. On the other 
hand, the miners of Reichenstein, who are constantly exposed 
to arsenic, as it is contained in large quantities in the ore, are 
shortlived. They are described as very subject in childhood to 
severe rickets and in adult life to dropsies and respiratory dis- 
eases; while they offer little resistance to microbial infection 
and frequently present the cutaneous and nervous symptoms 
of arsenical poisoning. A characteristic feature of the con- 
tinued use of arsenic in many instances is the imparting to the 
breath and sweat of the odor of garlic. The excretion of 



24O PHARMACOLOGY AND THERAPEUTICS. 

arsenic takes place so slowly that the drug may be discovered 
in the urine five months after the last dose has been taken, and 
it is well known that arsenic may be found many years after 
death in the bodies of those who have taken it during life. 
Even in toxic doses, however, it is not always capable of pre- 
serving the body from corruption, since in the intestines of per- 
sons who have been poisoned with arsenic trioxide, examined 
some months after death, the poison has been found in the 
state of yellow arsenic sulphide, into which it has been con- 
verted by the hydrogen sulphide developed by the putrefactive 
process taking place in the bowel. 

Untoward Effects. — In very susceptible persons there have 
occasionally been noticed, from the use of medicinal doses, cer- 
tain effects which differ from the ordinary symptoms of chronic 
or arsenical poisoning. Among them may be mentioned rest- 
lessness, headache, alopecia circumscripta, bronchitis and 
hoarseness; more rarely, epistaxis, amblyopia, and anaphrodisia. 

Therapeutics of Arsenical Compounds. 
External. — Arsenic trioxide, either pure or as a paste, was 
formerly much more used than at present as a caustic for 
destroying growths of various kinds. Marsden's paste con- 
sists of arsenic trioxide, 1 ; powdered acacia, 2 parts. Another 
paste which was once very popular consisted of arsenous acid, 
1 ; charcoal, 1 ; red mercuric sulphide, 4 parts ; and water 
sufficient to make a paste. Unless it is used in sufficient 
strength to make the mass of dead tissue slough out quickly, 
there is danger of the patient becoming poisoned, as the arsenic 
is rapidly absorbed. A caustic powder may be made of arsenic 
trioxide, 1; calomel, 8; vermilion antimony sulphide, 8 parts. 
Liquor Potassii Arsenitis is sometimes used as an application 
for corns. The ointment of oleate of arsenic (not official) 
makes a useful application in the treatment of old ulcers, epithe- 
lioma and lupus. Its efficiency is increased by the addition of 
a small amount of zinc chloride, and morphine sulphate may be 
incorporated with it to allay pain. Arsenous iodide in ointment 



ARSENIC. 24I 

(.30 gm. ; 5 gr. to 4 gm. ; 1 dr.) has been found a valuable 
stimulating application in old dry eczema. For lupus it may 
be made stronger, or may be combined with mercuric chloride. 
Mercurial ointment containing from 5 to 10 per cent, of 
arsenic has been advised for warts. Arsenic trioxide is now 
much employed for killing the nerves of teeth. As this requires 
several days, it illustrates the slowness of the corrosive action 
of arsenic. 

Internal. Alimentary Canal. — A course of arsenical treat- 
ment should always be commenced with small doses ; for in- 
stance, .20 to .25 c.c. (3 or 4 R) of Liquor Potassii Arsenitis, 
or .001 to .0015 gm. (-g-^ to J ? gr.) of arsenic trioxide in pill or 
tablet. The dose should usually then be gradually increased. In 
this way the gastric pain, nausea, diarrhoea and other symp- 
toms of poisoning which the drug is liable to produce may be 
avoided. Another precaution which should commonly be ob- 
served is to administer arsenic immediately after eating, in order 
that it may be diluted by the contents of a full stomach. When 
the dose used is minute, however, it is often best to give it be- 
fore meals. As a rule, children bear arsenic well, while the aged 
do not. As arsenic increases the appetite, it is useful as a 
tonic in many conditions, and it is also found of service in 
some forms of dyspepsia. Small doses sometimes check vomit- 
ing, and especially that variety in which there is simple regurgi- 
tation of the food. Liquor Potassii Arsenitis, in doses of .06 or 
.12 c.c. (1 or 2 TTL) before each meal proves efficient in some 
cases of the vomiting of pregnancy, as well as in the vomiting 
of chronic gastric catarrh, especially the alcoholic form. It is 
also very beneficial, given in the same way, in what is known 
as irritative dyspepsia, which is characterized by a red and 
pointed tongue, poor appetite, and distress after meals, the 
presence of the food causing intestinal pain, and the desire to 
go to stool. Arsenic in these small doses is furthermore of 
service in chronic gastric ulcer and also in cancer of the 
stomach, where it diminishes the pain and checks the vomiting; 
while gastrodynia and enteralgia, when idiopathic, are often 
17 



242 PHARMACOLOGY AND THERAPEUTICS. 

promptly relieved by it. In some of the conditions mentioned 
the effects of the arsenic are found to be increased by the con- 
joint administration of a little laudanum. In the treatment of 
stomach disorders it must be borne in mind that only small 
doses are admissi-ble, as larger ones will serve to irritate the 
mucous membrane, and thus defeat the end in view. Occa- 
sionally it will be found that arsenic is capable of controlling- 
diarrhoeas which prove unamenable to other remedies. It is 
especially useful in that form of diarrhoea dependent upon an 
intolerance of the presence of food, where the undigested ali- 
ment is evacuated soon after it is swallowed. Chronic diarrhoea 
and dysentery, particularly when due to malarial cachexia, may 
also often be greatly benefited by it. In these cases it is best 
to give .12 c.c. (2 HI) of Liquor Potassii Arsenitis with .30 
c.c. (5 TTL) of laudanum before meals. Arsenic has even been 
proposed as an appropriate remedy in Asiatic cholera. In cases 
of constipation where there is deficient intestinal secretion, with 
dry faeces, it sometimes acts well. It has proved of service in 
catarrhal jaundice, and is especially recommended when the 
trouble is of malarial origin. 

Remote Effects. — Arsenic is used to some extent in the 
treatment of anaemia, and especially in cases of what is desig- 
nated primary anaemia, including leucocythaemia, exophthalmic 
goitre, Hodgkin's disease, and pernicious anaemia. It may per- 
haps prove of service, but in these conditions all remedies 
sometimes seem without effect. In chlorosis and in cases of 
anaemia where iron disagrees with the patient or proves un- 
successful it is worthy of trial, and is considered by some 
clinicians one of the most valuable agents in the pharmacopoeia. 
In these disorders the efficiency of iron is at times much in- 
creased by the addition of arsenic. Although much inferior to 
that drug, it is next to quinine the most efficient remedy in 
malarial infection which we possess. It is in chronic cases that 
it is especially beneficial. Reference has already been made 
to its value in intestinal disorders due to such infection, and 
it is also of service (though distinctly less than quinine) in 



ARSENIC. 243 

various other affections when of malarial origin, such as hemi- 
crania and other neuralgias. As a prophylactic against malaria 
some of the observations made apparently indicate that arsenic 
is superior even to quinine. In a considerable number of ner- 
vous conditions, whether there is a malarial taint present or not, 
it is of value. Among these may be mentioned cerebral con- 
gestion, melancholy and hypochondria of the aged, and espe- 
cially chorea. In the latter it should be given in rapidly in- 
creasing doses. In paralysis agitans, as well as in local chorea 
and histrionic spasm, the subcutaneous injection of Fowler's 
solution or Pearson's solution of sodium arsenate (solution of 
sodium arsenate, U. S. P., 10 c.c. ; distilled water, 90 c.c.) has 
sometimes proved of great service. Arsenic employed by this 
method is also an efficient remedy in lymphadenoma and in 
malarial hypertrophy of the liver and spleen, and has been 
known to be successful in obstinate cases of general malaria 
which have resisted the action of quinine. Used either inter- 
nally or locally (often by fumigation in the form of arsenical 
cigarettes) arsenic is useful in chronic bronchitis, emphysema, 
spasmodic asthma, " hay asthma," chronic pneumonia (fibroid 
phthisis), and even pulmonary tuberculosis when the course of 
the disease is very slow. Arsenous iodide, .30 c.c. (5 ni) after 
each meal of a 1 per cent, solution, increased to .90 c.c. (15 TTi) 
or 1.20 c.c. (20 HI), has been found of value in the bronchitis 
of strumous children. In both acute and chronic coryza the 
fumes of arsenical cigarettes, snuffed into the nares, are of 
service. Such cigarettes may be made by saturating bibulous 
paper in a solution of 1 gm. (15 gr.) of potassium arsenate to 
30 c.c. (1 fl. oz.) of water. In short breathing from cardiac 
weakness, especially in elderly persons, arsenic is apt to afford 
relief, and attacks of angina pectoris may sometimes be lessened 
or prevented by the persistent use of the drug in the interval. 
A course of . arsenic often has a valuable tonic influence in 
organic heart disease, and under its use dyspnoea, palpitation, 
intermittency of the pulse, and oedema improve. It has been 
found very useful in a certain form of chronic arthritis, in 



244 PHARMACOLOGY AND THERAPEUTICS, 

which the joints become stiff and painful in consequence of 
a peculiar state of the nervous system; the trophic nerves being 
involved and the condition one allied to neuralgia. As to its 
value in the kind of chronic rheumatism or rheumatic gout 
which is accompanied by nodosities of the joints authorities 
differ. By some it is claimed that it is of considerable service 
in those forms of chronic rheumatism in which potassium iodide 
is commonly employed, and that it is often advantageous to 
administer these two alteratives alternately for periods of 
three or four weeks. Arsenic has been employed with good 
effect in albuminuria following scarlatina, and also appears to 
be useful in certain forms of chronic albuminuria. It is 
thought to be of considerable value in diabetes of hepatic origin, 
and at the present time Clemens' bromide solution (consisting 
of a solution in water of arsenic trioxide, bromide and potassium 
bicarbonate) is much in favor as a remedy for diabetes. Good 
results have also been claimed from the persevering use of 
small doses of arsenic in cirrhosis of the liver, in epithelioma, 
and in rodent ulcer, while some have believed that it is useful in 
scirrhus, especially as the disease manifests itself in the 
stomach, and in retarding the growth of uterine cancer. There 
appears to be good evidence that arsenic in large doses restrains 
the growth of sarcomata, particularly of the fusiform-cell va- 
riety. 

One of the most useful and general applications of the drug 
is in the treatment of diseases of the skin. As it exerts its in- 
fluence chiefly upon the epidermis, its action being upon nutri- 
tion through the nerves, diseases affecting the more superficial 
strata of the integument are most amenable to it, while it pro- 
duces a less marked effect upon those having their seat in the 
deeper structures. It should not be employed when there 
is great heat, burning, intense itching, or rapid cell-change, and 
should therefore rarely be prescribed in the acute inflammatory 
stage of any cutaneous affection. It is of great value in many 
cases of psoriasis, in certain varieties of eczema, especially in 
chronic squamous and papular forms of the disease, in acne of 



ARSENIC. 245 

the small papular variety, especially in neurotic cases, in certain 
glandular hypersecretory diseases of neurotic origin, such as 
seborrhcea and hyperidrosis, in lichen, and in pemphigus. It 
should be avoided in acute eczema unless the case is distinctly 
neurotic. It is sometimes of service in chronic urticaria, and 
also in morphcea, alopecia circumscripta, and other atropic dis- 
eases. Dermatologists hold that in all diseases of the skin be- 
fore arsenic is prescribed the digestive tract should be carefully 
investigated, and if any abnormal condition is shown, that this 
should be rectified. It is sometimes found that syphilitic affec- 
tions can be better treated by the combination of mercury with 
arsenic than by mercury alone, and Donovan's solution (Liquor 
Arseni et Hydrargyri Iodidi) is especially useful in old 
syphilitic skin lesions. Furunculosis may be successfully treated 
by the persistent use of arsenic, and small doses of it are 
said to have a curative effect upon warts. Given in associa- 
tion with the bromides, it is useful in lessening or preventing 
the disfiguring acne which so frequently results from the con- 
tinued administration of these drugs. 

The springs of Levico and La Bourboule contain arsenic tri- 
oxide. Strong Levico contains .005 gm. (-^ gr.) of arsenic 
trioxide and 2 gm. (30 gr.) of iron to 500 c.c. (1 pint) ; weak 
Levico, .0005 gm. ( t ^-q gr.) and 0.5 gm. (8 gr.) respectively. 
La Bourboule contains .005 gm. ( T ^.gr.) of arsenous acid and a 
trace of iron to 500 c.c. (1 pint). These waters should always 
be taken with the meals. 

Cacodylic acid (AsO(OH)0(CH 3 ) 2 ), (not official), and so- 
dium cacodylate (AsONa(CH 3 ) 2 ), (not official) have recently 
been proposed as eligible methods for the administration of 
arsenic. The former contains 58 per cent, of arsenic. Their 
solubility, relatively small toxicity, and the diminished local 
irritation which they produce are advantages to be borne in 
mind. The best form of administration is as sodium cacodylate, 
given hypodermatically in daily amount of from .05 to 15 gm. 
(24 to 2 l / 2 gr.), in solution. By this method the arsenic is 
fully efficacious, no alliaceous odor is given to the breath or 



246 PHARMACOLOGY AND THERAPEUTICS. 

perspiration, and gastric and intestinal disturbances do not 
supervene. Prolonged use, however, may set up albuminuria. 
By the rectum it produces less irritation and the odor of garlic 
is not so pronounced as after the use of Fowler's solution. This 
method is preferable in the treatment of tuberculosis, diabetes, 
Basedow's disease, and leukaemia. It has been objected against 
the use of the cacodylates that if they can be administered in 
comparatively large doses without producing characteristic 
symptoms of the action of arsenic, it must be because the arsenic 
ion has been rendered inert; the reason for this probably being 
that in these substances there is formed so firm and stable a 
union of the arsenic with other ingredients that no dissociating 
influence to which it is subjected in the body is capable of 
setting free the active arsenic ion from the combination. It 
is also claimed that in several diseases in which the older 
arsenical compounds are given with advantage no therapeutic 
results assignable to arsenic have been obtained from the caco- 
dylates; and, furthermore, that when these are administered, 
they pass through the system and are eliminated in such stable 
combinations with organic bodies that they fail to react to the 
usual tests for arsenates, and fail to yield arsenicum when sub- 
jected to the dissociating influence of Marsh's process. To 
these objections it may be answered that while the cacodylates 
are absorbed but slowly and the arsenic ion is dissociated with 
difficulty, they do produce distinct arsenical effects in the body, 
as has been unquestionably shown by the fact that cases are on 
record in which poisoning with the characteristic symptoms of 
arsenic has occurred. In addition, this has been demonstrated 
by the fact that in some diseases, at all events, in which the 
ordinary compounds are known to be efficient, equally good re- 
sults have been obtained from the use of the cacodylates. In 
seeking for a cause for this discrepancy between observers at- 
tention should be called to the fact that the strongest objection 
to the use of the cacodylates has been made by those who have 
administered them by the mouth. When given hypodermatic- 
ally several disadvantages are obviated; the garlic-like odor of 



ARSENIC. 247 

the breath, intestinal irritation, etc. Quite lately a new com- 
pound, disodic-methyl-arsenate (AsCH 3 3 Na 2 H 2 2 ), to which 
the name of arrhenal has been given, has been brought forward 

as an agent which, it is asserted, is free from certain alleged 
disadvantages of other similar compounds, and for which some- 
what extravagant claims have been made for its efficacy in 
bronchitis, tuberculosis, chorea, syphilis, anaemia, adenitis, 
leukaemia, malaria, and other affections. These claims have 
already been disputed, and it is as yet too soon to form any 
positive opinion regarding its merits. It is stated to be non- 
toxic, and is given in quite large doses, ranging from .18 to 2.5 
gm. (3 to 40 gr.) daily. 

TOXICOLOGY. 

Acute Poisoning. — Arsenic is used to a very considerable extent for 
poisonous purposes. The forms most employed are Scheele's and Paris 
Green (cupric arsenite), and Schweinfurth's Green (a compound of 
cupric arsenite and arsenate). Symptoms. — As the pathology of the 
effects of arsenical salts in the alimentary canal is practically the same 
as that of Asiatic cholera, so the symptoms of poisoning by them gen- 
erally resemble very closely those met with in that disease. Large 
doses frequently produce no distress for a considerable time, but in the 
course of half an hour, or perhaps longer, the patient experiences a 
sense of constriction in the fauces, with dysphagia. About the same 
time he begins to suffer from slight epigastric pain, which soon becomes 
extreme, and spreads over the abdomen. It is accompanied with faint- 
ness, nausea and excessive vomiting, and later by profuse watery diar- 
rhoea, with tenesmus and intense thirst. The matter vomited and the 
stools may contain blood, but this is not infrequently absent. The pa- 
tient also suffers from muscular cramps, headache and dizziness, and 
gradually sinks into collapse, with coldness of the extremities, pallor, 
small and feeble pulse, and sighing respiration. This condition passes 
into one of coma, followed by death, which may or may not be pre- 
ceded by convulsions. Exceptional cases have been noted in which the 
only symptoms were those of collapse and coma. Death may perhaps 
occur within twenty-four hours, but more commonly the vital powers 
are not exhausted for considerably longer than this, and the patient 
may linger for several days. Not infrequently it is found to be the 
case that he recovers from the acute symptoms only to develop those 
of chronic arsenical poisoning. 



248 PHARMACOLOGY AND THERAPEUTICS. 

Post-mortem. — The mucous membrane of the gastro-intestinal tract is 
generally red and swollen, while its epithelial coat in many places can 
be readily detached and is found to be in a state of fatty degeneration. 
As a rule, no erosion is observed unless the arsenic has been swallowed 
in powder, when, if the latter has remained for some time in contact 
with the wall of the stomach, there may perhaps be some erosion, as 
well as more marked congestion, as the result of its local action. In 
the intestine the swelling and congestion of the mucous membrane is 
most pronounced around Peyer's patches, and the bowel generally con- 
tains a considerable quantity of thin fluid with flakes of membrane, like 
the rice-water discharges of cholera. Haemorrhage is only occasionally 
met with, but in both the stomach and intestine small particles of ar- 
senic are not infrequently observed. 

Treatment. — It is important that the stomach should be completely 
emptied as soon as possible, either by washing out or the use of emetics 
(see p. 175), choice being made of those least depressing and least 
irritating. On account of the insolubility of arsenic it is advisable that 
the stomach washing should be continued for some time. At the same 
time large quantities of freshly prepared ferric hydroxide with mag- 
nesium oxide (see p. 230) or dialyzed iron should be given ; if these 
cannot be obtained, magnesia (preferably light magnesia) shaken up 
with water. The antidote must be repeated at intervals as long as the 
acute symptoms continue. If neither magnesia nor the iron prepara- 
tions are procurable, dependence must be placed on large doses of 
castor oil and water. For the collapse subcutaneous injections of 
brandy or ether may be given, and warm applications made to the 
abdomen and extremities. 

Chronic Poisoning. — When arsenic is given medicinally, too large 
doses may induce slight symptoms of poisoning, such as abdominal pain, 
loss of appetite, nausea, indigestion, mild diarrhoea, pumness of the eye- 
lids, injection of the conjunctiva, and watering of the eyes and nose. 

Cutaneous eruptions are also sometimes caused, and while these may 
be due in part to circulatory derangements, they are believed to result 
chiefly from a direct action of the drug on the skin. They may be 
erythematous, papular, vesicular or pustular in character, and may be 
attended with erysipelatous swelling. Herpes zoster, it is said, has been 
caused by its prolonged administration. As arsenic is very extensively 
used in the arts, particularly in the manufacture of wall papers and 
fabrics, accidental poisoning is not infrequent among workers in arsenic 
and may occur in persons using articles which contain it. The evidence 
in regard to chronic poisoning from occupancy of rooms decorated with 



DRUGS ACTING ON CARDIAC MECHANISM. 249 

arsenical wall paper is somewhat contradictory, but the facts point 
towards its probability. Quite as often the poisoning is due to the 
arsenic which is a contamination of aniline dyes as it is to the arsenical 
pigments, so that the color should not be depended upon, but rather a 
chemical examination. 

As the arsenical poisoning goes on, a catarrhal condition of the mu- 
cous membrane of the nose and throat is developed, with much sneezing 
and coughing, cutaneous eruptions of various kinds appear, and, in some 
instances, a curious pigmentation of the skin occurs (arsenic melanosis) ; 
while eventually the hair and nails fall out. Swelling of the liver, with 
jaundice, is sometimes met with, and the later phases of the disorder 
are characterized by sensory and motor disturbances in localized areas 
(generally in the hands and feet), the result of polyneuritis. There 
are acute pain and formication in the extremities, followed by sensory 
paralysis, with symptoms resembling those of locomotor ataxia. This 
again is succeeded by motor paralysis, which as a rule is confined to the 
extremities, but may possibly invade the trunk. It is generally sym- 
metrical and the affected muscles (more commonly the extensors than 
the flexors) atrophy quite rapidly. Herpes of the face or trunk, of 
nervous origin, is a common symptom. In very prolonged cases the 
patient may sink into an apathetic, semi-idiotic condition, or may be- 
come epileptic. After death from chronic poisoning, in addition to the 
gastro-intestinal and nervous lesions, there is found fatty degeneration 
of most of the organs of the body, and particularly the liver, kidneys, 
stomach and muscles, including the heart. 

The tests for arsenic are so simple that every physician should be 
able to make use of them. They are: (1) Reinsch's. — Hydrochloric 
acid and a clean slip of copper are boiled in the suspected liquid. Bluish 
spots indicate the poison. (2) Marsh's. — Diluted sulphuric acid and 
zinc are introduced into a flask with the suspected liquid. The gas issu- 
ing from the tube is ignited and the flame allowed to impinge upon a 
clean porcelain plate forming a steel-white mirror if arsenic be present ; 
or the delivery tube may be heated when the mirror will be deposited 
upon it. This mirror is distinguished from that produced by antimony 
by its solubility in potassium hypochlorite if arsenic is the cause. 

Division III. — Drugs Acting on the Cardiac Mechanism. 
While it was formerly supposed that the spontaneous im- 
pulses originating in the heart, which normally commence in 
the sinus venosus and extend downwards over the auricle and 
ventricle to the apex, had their birth in the cardiac ganglia, the 



2 50 PHARMACOLOGY AND THERAPEUTICS. 

real function of these ganglia (which may possibly be a nutri- 
tive one), is still practically unknown, and there is now at 
command considerable evidence to the effect that it is in con- 
sequence of impulses originating in themselves that the muscu- 
lar fibres contract. The contractile function of the muscular 
fibres is, however, subject to two opposing influences, one that 
of the accelerator nerve-fibres connected with the sympathetic, 
which tends to augment it, and the other that of the pneumo- 
gastric, or vagus, which tends to inhibit it. In studying the 
effects of drugs on the heart, therefore, all that we are called 
upon to consider is their action on the muscular structure of 
the heart, on the nerve-fibres distributed to it from the vagus 
and the sympathetic, and on the vagus and accelerator centres 
in the medulla oblongata. These centres, it may be stated, are 
extremely sensitive to afferent impulses conveyed from various 
parts of the body, as well as from the heart itself. Our knowl- 
edge of the action of drugs upon the human heart is necessarily 
somewhat imperfect, since it is principally derived from experi- 
mentation on animals, in connection with which there are a 
number of difficulties and sources of error. Thus, many ex- 
periments cannot be satisfactorily made upon the mammalian 
heart, and hence the cold-blooded animals have been made use 
of to a large extent. As some differences have been observed 
among them (as, for instance, between the frog and the tor- 
toise) it is a question how far deductions from experiments 
upon the hearts of warm-blooded animals, among which, again, 
decided differences are sometimes found, are applicable to the 
human heart. A uniformity of effect will naturally go far to 
establish the character of any given action as regards man, but 
in general we have to depend largely on probabilities in this 
matter. Attention may here be directed to one point of inter- 
est; the action of a large dose of a drug is as a rule the oppo- 
site of that of a moderate dose. 

A. Drugs Acting Upon the Heart Directly. — Our knowledge 
of these has been derived from the application to the heart of 
a solution of the drug externally, or by means of a transfusion 



DRUGS ACTING ON CARDIAC MECHANISM. 25 I 

cannula, and by the action of the drug upon the excised heart 
or section of a heart. Since the apex probably contains no 
nerves, it is customary to conclude that if a drug has an action 
on the isolated apex it acts exclusively upon the muscles ; but 
as it is always a difficult matter to decide whether a drug acts 
upon the muscle fibre itself or upon the fine nerves between the 
fibres, it will be found advisable to make no attempt to distin- 
guish between these actions. In studying the nervous influ- 
ences affecting the heart's action much more attention has been 
paid to the inhibitory or vagus than to the accelerating mechan- 
ism. The effect of stimulating the muscle is the same as that 
of stimulating the accelerator fibres, and consists in an augmen- 
tation of either the rate or the force of the beat, or both. On 
the other hand, stimulation of the vagus fibres or its cardiac 
terminations may cause a diminution in either the rate or the 
force of the beat, or both; while the paralyzing of either the 
accelerator or vagus terminations naturally produces an effect 
just the opposite to their stimulation. As it is very difficult to 
decide whether drugs act upon the muscle or on the nerve- 
endings, it will be most convenient to classify those which act 
locally on the heart by the effect they produce, without refer- 
ence to this point. 

Drugs increasing the force of the contraction : 

(1) Digitalis. (6) Caffeine. 

(2) Strophanthus. (7) Veratrine. 

(3) Adonidin. (8) Erythrophloeum. 

(4) Squill. (9) Barium Salts. 

(5) Convallaria Majalis. 

In frogs these drugs, in large doses, always cause arrest of the heart 
in systole ; in mammals the final arrest may be in diastole with some, 
e. g., digitalis. They all slow the pulse. 

(10) Camphor. | (13) Dilute solutions of zinc 

(11) Musk. double salts. 

(12) Dilute solutions of cop- j (14) Dilute solutions of chloral. 

per double salts. I (15) Physostigmine. 

These drugs have the same action without the final arrest in systole. 
The rate of the pulse is not markedly altered. 



252 



PHARMACOLOGY AND THERAPEUTICS. 



Drugs the chief action of which is to decrease the force of the con- 
traction, usually with stoppage in diastole : 



(1) Diluted acids. 

(2) Strong solutions of salts 

of the alkaline metals. 

(3) Strong solutions of ba- 

rium salts. 

(4) Strong solutions of cop- 

per double salts. 

(5) Strong solutions of zinc 

double salts. 



(6) Strong solutions of chloral. 

(7) Muscarine. 

(8) Pilocarpine. 

(9) Saponin (large doses). 

(10) Apomorphine. 

(11) Emetine. 

(12) Salicylic acid (large doses). 



Drugs an important action of which is to increase the rate of the car- 
diac beat: 



(1) Atropine. 

(2) Hyoscyamine. 

(3) Daturine. 



(4) Duboisine. 

(5) Cocaine. 

(6) Saponin. 



Drugs an important action of which is to slozv the rate of the cardiac 
beat (see also first list given above) : 

(1) Muscarine. (2) Pilocarpine. 

Drugs which increase both the force and the number of the beats: 



(1) Ammonium salts. 

(2) Alcohol. 

(3) Ether. 

(4) Chloroform. 

(5) Cactus. 



(6) Anaesthetics. 

(7) Arsenical salts. 

(8) Quinine. 

(9) Strychnine. 



Drugs which decrease both the force and the number of the beats. 



(1) Antimony salts. 

(2) Aconite. 

(3) Hydrocyanic acid. 



(4) Ergot. 

(5) Veratrum. 

(6) Cevadilla. 



B. Drugs Acting on the Vagus Centre. — It may be concluded 
that a drug acts on the vagus centre when it is found that while 
it has the effect of altering the beat of the heart, such altera- 
tion may be counteracted either by section of the vagi or by 
stimulation of the peripheral end of the nerve, if only one of 
the vagi be cut. 



DIGITALIS. 



253 



Drugs which stimulate the vagus centre: that is to say, the pulse is 
slowed, but this slowing disappears on section of the vagi : 



(1) Chloroform. 

(2) Hydrated Chloral. 

(3) Butyl-chloral hydrate. 

(4) Aconite. 

(5) Veratrum. 

(6) Nicotine. 

(7) Digitalis. 

(8) Sparteine. 

(9) Strophanthus. 
(10) Squill. 



(11) Convallaria Majalis. 

(12) Hydrocyanic acid. 

(13) Cocaine (large doses). 

(14) Staphisagr ia ( Delphinine ) . 

(15) Atropine ■>. Only very 

(16) Hyoscyamine L e a r 1 y in 

(17) Daturine J their action. 

(18) Increased blood-pressure. 

(19) Venous blood. 



Drugs which depress the vagus centre: Large doses of the drugs men- 
tioned in the last list, and drugs which diminish the blood-pressure, such 
as amyl nitrite, nitroglycerin and the nitrites. 

C. Drugs Acting on the Accelerating Centre. — So far as 

known, there are no drugs which have the effect of depressing 
this. Probably some stimulate it, for their administration ren- 
ders the pulse still more rapid after the vagi have been cut. 



They are — 

(1) Ammonia. 

(2) Caffeine. 

(3) Picrotoxin. 



(4) Cactus. 

(5) Delphinine. 

(6) Any drugs which make 

the blood venous. 



Therapeutics. — The drugs most used for their action on the 
heart are digitalis, strophanthus, ammonium salts, sparteine, 
squill, convallaria majalis, caffeine, alcohol, ether, chloroform, 
cactus, strychnine, belladonna, aconite, antimony, and hydro- 
cyanic acid. The various indications for which they are 
severally given will be mentioned under each drug. 



A. Drugs Acting Upon the Heart Directly. 
DIGITALIS. 

DIGITALIS.— Digitalis. (Foxglove.) Dose, 0.065 gm, (65 mil- 
ligm.); 1 gr. 



2 54 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Extractum Digitalis.— Extract of Digitalis. Dose, 0.010 
gm. (10 milligm.) ; y 5 gr. 

2. Fluidextractum Digitalis. — Fluidextract of Digitalis. 
Dose, 0.05 c.c.; 1 TTt- 

3. Infusum Digitalis. — Infusion of Digitalis. Dose, 8 c.c; 
2 fl. dr. 

4. Tinctura Digitalis. — Tincture of Digitalis, Dose, 5 c.c; 
15 HI. 

Unofficial Preparations. 
Digitalinum. — Digitalin. Dose, 1 mg.; ^ ¥ gr. 



Digitoxinum. — Digitoxin. Dose, .00025 to .00032 gm.; 



i 

2S0 



Action of Digitalis. 

External. — It has but little effect on the skin; its principal 
local action being on the mucous membranes, where the primary 
irritation caused by it is not infrequently followed by paralysis 
of the nerve endings. 

Internal. G astro-intestinal Tract. — It causes gastrointesti- 
nal irritation, and in large doses gives rise to gastritis and 
purging, with green stools. There is some ground for suppos- 
ing that these disturbances are in part at least of centric origin. 

Blood. — It has no appreciable effect upon the blood. 

Heart. — Digitalis has a pronounced effect upon the heart. 
This is due principally to its direct action on the cardiac .mus- 
cle, but also, in part, to stimulation of the vagus apparatus, both 
in the medulla and peripherally. Applied locally to the heart 
of a frog, digitalis is capable of causing tonic contraction of the 
organ. It will also increase the force of the contraction when 
applied to the isolated apex, in which no nerves are believed to 
exist, and act on the embryonic heart of the chick before the 
nerves are developed. 

The influence digitalis exerts may be divided into three 
stages. In the first, or therapeutic, stage the rhythm of the 
heart is markedly slowed, and the ventricles, emptying them- 



DIGITALIS. 255 

selves more thoroughly than under normal conditions, become 
diminished in size. As the contraction of the ventricle is more 
complete, the blood is expelled into the vessels under greater 
pressure than normally. Relaxation of the ventricle during 
diastole is also increased in the healthy heart, but if the organ 
is weak and dilated, digitalis tends to diminish the relaxation. 
The auricles are slowed, as well as the ventricles, but in general 
they are not so much affected as the ventricles. The diastole is 
prolonged, the force of the systole increased, and the size of the 
individual pulse-wave also increased. If the heart is beating at 
its normal rate the diastole is increased by digitalis, but if the 
beat is slow, and the slowness is due to weakness of the cardiac 
muscle, the diastole is diminished instead. The slowing of the 
pulse caused by the drug is apparently due to a simultaneous 
stimulation of both the central and peripheral vagus apparatus, 
since it has been demonstrated that in the mammal the admin- 
istration of atropine entirely does away with this slowing. 
Moreover, if section of the vagi is made, the slowing is much 
less than when these nerves are left intact, and may be alto- 
gether absent. Under digitalis the work done by the heart is 
much greater than normal, and the slowness developed is not 
sufficient to counterbalance the increased output at each ventri- 
cular contraction. 

In the second stage the pulse is very slow and irregular, for 
the reason that the inhibitory mechanism is powerfully stimu- 
lated. During diastole the ventricle dilates more completely 
than usual, while its systole varies in force. The contraction 
of the auricle becomes much weakened, and sometimes the 
rhythm of the latter is different from that of the ventricle. 
Under certain circumstances this stage may be absent. 

The third stage is always developed if a sufficient quantity 
of the drug be given. In this the heart's action becomes ex- 
tremely fast and irregular. This accelerated rate is believed to 
be due, not to paralysis of the pneumogastric centres and car- 
diac peripheral filaments, but to such an increased excitability 
of the heart muscle that the inhibitory apparatus can no longer 



256 PHARMACOLOGY AND THERAPEUTICS. 

hold it in check. The rhythm of the ventricle continues to in- 
crease, but the strength of its contractions diminishes. The 
output of the heart continues much augmented during the first 
part of the third stage, and then rapidly declines. The auricle 
passes into the condition known as delirium cordis, and finally 
the ventricle also. Then the circulation is arrested; after 
which the heart dilates to an extreme degree. 

The action of digitalis on the heart has been very carefully 
studied in the frog, and it is found that in general its effects on 
the mammalian heart resemble those on the batrachian. The 
contraction, however, is not prolonged as it is in the latter, and 
the inhibitory action is of greater importance. In the frog the 
drug causes systolic arrest of the heart, while in man the arrest 
is in diastole. The reason for this difference is supposed to 
be that the mammalian heart is not capable of continuous 
systole. 

Vessels. — Digitalis has the effect of markedly increasing the 
biood-pressure in the vessels. Three factors are concerned in 
producing this result namely: The expulsion from the heart of 
more blood than usual and at a higher pressure, the stimulation 
of the vaso-motor centres, and the direct action of the drug on 
the vessels themselves, exciting a condition of abnormal activity 
in their muscular coats, and thus diminishing their calibre. If 
digitalis is injected into a frog and a small artery in its foot 
is measured, it will be found that during the action of the drug 
the calibre of the vessel is diminished to about three fourths 
its natural size; and the mammalian kidney is also found to 
decrease in size under digitalis. That the constriction of the 
arteries from digitalis is to a great extent a muscular action is 
shown by the fact that it occurs in organs which have been 
excised, even for several hours; but, as this constriction is not 
as marked as when the drug is administered under normal con- 
ditions, the agency of the vaso-constrictor centres must also 
be recognized. While the blood-pressure rises in the arteries 
the velocity of the current diminishes, and as the pressure rises 
in the arteries it declines in the veins; both these effects indi- 
cating an increased resistance. 



DIGITALIS. 2 57 

Under toxic doses of digitalis the blood-pressure in the 
vessels diminishes with the extreme slowing of the heart, but 
as the latter becomes accelerated it again rises to a pronounced 
degree; this result being due to the quickened heart and con- 
traction of the arterioles. Then, as the heart becomes irregu- 
lar, the blood-pressure declines until it finally reaches zero 
when the heart stops. This fall results from the decreasing 
efficiency of the cardiac contractions and from vaso-motor 
paralysis. 

Some former experiments, made for the purpose of demon- 
strating the action of digitalis and its allies upon the vessels, 
have recently been repeated. The new experiments were con- 
ducted on dogs. Two entirely different methods were em- 
ployed: in one the amount of blood flowing out of the veins of 
different regions was registered after a sufficient amount of 
atropine had been given to overcome the slowing of the 
pulse; in the other the plethysmograph was used. The ex- 
periments showed that the increased blood-pressure is due to 
increased heart action and contraction of the vessels, and that 
the latter is due to peripheral action which, in the case of 
digitoxin, is general. In the case of the other glycosides ex- 
amined (digitalin, convallamarin, strophanthin) the action is 
restricted to the splanchnic area. There is, however, some 
active constriction going on here in the peripheral vessels, yet 
this is overcome by a passive dilatation, owing to reflux of 
blood from the intestines and an active reflex dilatation set up 
by the splanchnic contraction. The general narrowing of the 
pathway of the blood seen with digitoxin gives a high resistance 
which must be overcome by the heart; strophanthin, etc., open 
the vessels of the periphery, and this materially relieves this 
organ. 

Kidney. — In dropsy, especially when due to cardiac disease, 
there is no question as to the value of digitalis as a diuretic, 
though its action has been explained in a variety of ways. It 
has been disputed, however, whether in health it has any effect 
on the renal secretion. The weight of authority seems to favor 
18 



258 PHARMACOLOGY AND THERAPEUTICS. 

the view that it does exert some diuretic action, but this has 
proved so variable as to lead to the conclusion that it is prob- 
ably, to a large extent at least, of an indirect, rather than a di- 
rect, nature. Nearly all are agreed that the kidneys are 
affected principally through changes in the circulation, and per- 
haps the most satisfactory explanation of this is that the diure- 
sis is due to the cardiac action of the drug. Under this hypo- 
thesis it is supposed that arterial accumulation, with diminished 
venous pressure, leads to an increased flow of lymph into the 
blood-vessels. The blood is thus diluted, and the kidneys incited 
to special activity, while at the same time the nutrition of the 
organs is improved. In addition to this indirect action, there is 
some ground for believing that digitalis exerts a limited in- 
fluence directly upon the renal epithelium, on which it probably 
acts as a mild irritant. By the diuretic action of the drug the 
fluid of the urine is said to be much more largely increased than 
the solids. As to its effect upon the urea and other urinary 
constituents, the reports of various observers have been so con- 
flicting that no definite conclusions can be arrived at. 

Temperature. — In health digitalis, in medicinal doses, has 
little or no effect on the temperature. In febrile conditions it 
has an antipyretic action, but this is somewhat uncertain. 
Toxic doses cause a sustained reduction of temperature, 
amounting to several degrees, but their first effect is to increase 
it. It is thought by some that this temporary elevation may be 
due to the local irritation of the drug, and that if this can be 
avoided the fall will occur without the antecedent rise. Others 
explain the phenomena observed as follows: Owing to the in- 
creased resistance from diminution of the calibre of the arter- 
ioles, the actual energy expended by the heart is in part con- 
verted into heat. Subsequently the slowing of the circulation, 
especially through the lungs, hinders the combustion process, 
and hence the fall of temperature. 

Respiration. — It has little or no effect on respiration unless 
taken in toxic quantity, when, it is said, the respiratory move- 
ments become deep and rapid from central nervous stimulation. 



DIGITALIS. 259 

Nervous System and Muscles. — In therapeutic doses the only 
effect of digitalis appears to be the stimulation of the inhibitory 
cardiac and the vaso-motor centres in the medulla oblongata. 
Toxic doses, however, stimulate other centres, and general 
convulsions may eventually result. They diminish reflex ac- 
tivity by directly exciting the reflex inhibitory centres of 
Setschenow in the medulla, and afterwards by depressing the 
spinal cord. Finally the motor nerve-trunks are depressed and 
the muscles are paralyzed. While the cerebrum is not directly 
affected by digitalis, the disturbances in its circulation caused 
by the drug are liable to give rise to severe headache, excessive 
vomiting, dizziness, vertigo, confusion of sight, and possibly 
hallucinations and delirium. In some instances the whole field 
of vision is said to be blue and in others yellow. Exophthalmos 
occurs, and a peculiar blue color of the sclerotic has been quite 
constantly noted in acute poisoning. 

Uterus. — Digitalis appears to have some influence on the 
non-striated muscular fibres throughout the body, and it thus 
acts like ergot in causing contraction of the uterus. 

Therapeutics of Digitalis. 

External. — Digitalis is sometimes used externally in the form 
of a poultice made from the leaves, and placed over the loins in 
cases of renal congestion. It has also been found serviceable 
in chilblains, in the form of a lotion in which tincture of digi- 
talis is combined with thymol, alcohol and glycerin. 

Internal. — The most important use of digitalis is in affections 
of the heart, in which it is of very great value. It is indicated, 
in general, when the cardiac action is rapid and feeble, with 
low arterial tension, and contra-indicated when the cardiac ac- 
tion is strong and arterial tension high. It not only slows 
and steadies the heart, but also improves the nutrition of its 
walls by its stimulating influence on the pneumogastric nerve, 
as well as by increasing the blood supply of the heart muscle by 
rendering the systole more complete and prolonging the diastole. 
By its action the pressure in the coronary arteries is increased, 



26o PHARMACOLOGY AND THERAPEUTICS. 

and more time allowed for their filling. The benefit derived 
from the drug in not too inveterate cardiac disease is often in a 
measure permanent, by reason of the assistance which it affords 
in the production of compensatory hypertrophy. The relief of 
the circulation caused by it may in time bring about permanent 
nutritive changes in the heart-muscle, which is stimulated to 
such a marked degree by it, and dilatation is clearly less apt to 
occur when the muscular fibre is toned up and acting vigorously 
than when it is lax and acting feebly. The constriction of the 
peripheral vessels caused by it has been thought by some to con- 
stitute a valid objection to the use of digitalis, but this may 
not really be sufficient to seriously interfere with the increased 
cardiac power secured, while if such is the case, it may be 
counteracted by means of drugs having an opposing action, as 
will be more particularly dwelt upon later. 

Cumulative Effect and Contra-indications. — Digitalis should 
always be administered with caution, and it is advisable to 
commence with small doses, which may afterwards be gradu- 
ally increased, if necessary. A patient taking full doses of the 
drug should preferably be kept in the recumbent posture. 
When, under its influence, the pulse has become much reduced, 
on rising the heart is sometimes suddenly found unequal to 
maintaining the circulation in face of the increased resistance 
in the arterioles, and against the force of gravity ; so that fatal 
syncope may occur. Digitalis should always be stopped as 
soon as symptoms of gastro-intestinal irritation supervene, or 
the pulse becomes abnormally slow. In case the tincture is 
employed, what is known as the fat-free tincture of digitalis 
will be found less likely to disagree with the stomach than the 
official preparation. In this the fixed oil of the leaf and its free 
acids are eliminated. It must not be forgotten that digitalis 
has a cumulative effect, and this is probably due to vaso-spasm 
and to the fact that if the drug is too closely pressed it is not 
excreted by the kidneys as fast as it is absorbed, and conse- 
quently accumulates in the system. It sometimes happens, there- 



DIGITALIS. 26l 

fore, that, without any increase in the dose, individuals who 
have been kept on digitalis for a long period suddenly develop 
symptoms of poisoning by it. Such an untoward result may be 
avoided if the doses are given at proper intervals; the effects 
of each being allowed to subside before the next is administered. 
The plan has been adopted by some of stopping the remedy for 
several days at the end of each week. Others continue it for 
ten days, then intermit for four days and begin again. It 
should be kept up no longer than is necessary to re-establish 
compensation. Digitalis is contra-indicated in cases where, 
with dilatation there is extensive degeneration of the muscular 
wall, as the muscle is likely to be too weak to respond to its 
stimulus. Under these circumstances, the digitalis increasing 
the pressure against which the heart has to contract, the most 
serious results may occur. Thus the systole becomes even 
weaker than before its administration, and cerebral anaemia, 
syncope, and perhaps sudden death may ensue. Some individ- 
uals are unable to take digitalis at all, on account of the nausea 
which it produces. 

Mitral Regurgitation. — It is especially valuable in those cases 
of mitral disease in which compensation (that is, the adapta- 
tion of the organs of circulation to the unusual conditions im- 
posed upon them by the valvular lesion), has begun to fail. In 
mitral insufficiency the good effect caused by it is principally 
due to its tonic action in tending to produce a permanent sys- 
tolic condition, in consequence of which the rings of the valves 
are narrowed and brought together, and the orifice rendered 
smaller. In this way it abolishes the effects of the distention 
and tends to lessen the insufficiency. As regards the adminis- 
tration of digitalis, cases of mitral regurgitaton have been 
divided into three groups, as follows : ( 1 ) Those in which the 
ventricle is but little enlarged, while the nutrition of its 
muscular wall is still well-preserved, and which may be at- 
tended with perhaps no inconvenience except more or less 
dyspnoea (usually but slight) on exertion. (2) Those in which 
cardiac dropsy, of greater or less extent, is present. (3) Those 



262 PHARMACOLOGY AND THERAPEUTICS. 

in which, with extensive dilatation, there is little or no cardiac 
dropsy, but well-marked symptoms of pulmonary congestion. 
In the last two varieties digitalis is of the greatest service. By 
increasing the force of the left ventricle's contraction it causes 
the approximation of the mitral flaps, thus reducing the amount 
of the regurgitation and diminishing venous congestion. Under 
the action of the drug the increased force of the systole will 
throw proportionately more blood through the aortic orifice than 
through the partially open and obstructed mitral valve, and, the 
larger orifice eventually gaining on the smaller, more blood will 
pass into the general circulation, and the pulmonic vessels be 
relieved. The prolonged diastole will also be of service in 
allowing more time for the blood to flow into the left ventricle. 
Thus, both the auricles and ventricles gain increased power to 
empty themselves, and the longer intervals between the pulsa- 
tions enable the former to more completely discharge their con- 
tents into the ventricles. The favorable action of the drug, 
therefore, is seen (1) in increasing the length of the diastole 
and thus improving the nutrition of the cardiac walls; (2) in 
increasing the tonic contraction of the heart, and thereby dimin- 
ishing the size of the dilated cavity; (3) in increasing the 
force of the pulsations; and (4) in causing more slowness and 
regularity in the cardiac rhythm. The general improvement 
in the circulation caused by it has an excellent effect in reliev- 
ing the cardiac pain and distress and the dyspnoea and cyanosis 
incident to the disease, and the more a case of mitral regurgita- 
tion is characterized by the oedematous type the more efficient 
will the drug prove. In addition, therefore, to its direct action 
on the heart, the beneficial effects of digitalis are shown in a 
variety of ways. One of the most prompt results of its ad- 
ministration is a marked increase in the quantity of urine, and 
hence it is of essential service in relieving cardiac dropsy. 
Here it not only regulates the circulation, by its action on the 
heart, and causes the evacuation of the surplus fluid through 
the kidneys, but also acts directly on the vessels by increasing 
vasomotor force. In some cases the diuretic effect of digitalis is 



DIGITALIS. 263 

materially assisted by the administration in connection with it of 
an alkaline diuretic, such as potassium bitartrate or citrate, and 
occasionally it may be found that diuresis can be established 
only after free purgation. Owing to the disordered circulation, 
sleeplessness is often a marked symptom of serious cardiac 
disease. The normal relationship between the cerebral vessels 
and the general circulation is not maintained, and by restoring 
this balance digitalis gives the patient ability to sleep. The 
dyspnoea is relieved by the action of the drug in establishing a 
more efficient pulmonary circulation. By improving the venous 
flow towards the heart it will thus be of service in counteract- 
ing the venous engorgement and oedema of the lungs, the right 
side of the heart, the liver, the kidneys, and the subcutaneous 
tissues so commonly met with. 

There are some instances of mitral regurgitation in which 
digitalis seems to be indicated and yet in which it proves in- 
jurious rather than beneficial. This may b.e due, in a portion 
of the cases at least, to its causing too great a strain upon the 
auricle. The ventricle, as has been stated, is more affected by 
the drug than the auricle, and as with a very patulous mitral 
valve the blood is readily backed upon the auricle, the latter, 
already too weak for the ventricle, cannot well withstand the 
strain imposed upon it by the ventricle thus stimulated. Con- 
versely to the statement previously made, the less closely a case 
of mitral regurgitation approaches the oedematous type, the less 
the benefit which is likely to be derived from digitalis in it. 

Mitral Stenosis. — In most cases of mitral stenosis the same 
benefit will attend the administration of digitalis as in cases of 
regurgitation. The increased resistance here leads to the 
same general results as the leakage in mitral insufficiency, 
and, like the latter, it can be successfully combated by the 
effect of the drug in strengthening the heart-beat. The length- 
ening of the diastole caused by it will allow more time for the 
auricle, the contracting power of which is at the same time 
increased, to empty itself into the ventricle through the con- 
stricted orifice. The ventricle, thus more perfectly filled, sends 



264 PHARMACOLOGY AND THERAPEUTICS. 

out more blood into the systemic circulation. In addition, the 
circulation is further improved by the stimulating effect of the 
digitalis on the right ventricle, which enables it to overcome the 
tendency to congestion arising from the obstruction on the left 
side of the heart, and affords it greater power to force the 
blood through the lungs. It is possible, however, that the 
increased work of the right ventricle, combined with the steno- 
sis of the mitral valve, may tend to produce congestion of the 
pulmonary vessels, with the result of lessening the oxygenation 
of the blood and so interfering with the nutrition of the heart. 
On the other hand, the slowing of the organ will afford the 
lungs more time in which to empty into the heart; so that in 
the great majority of well-selected cases the beneficial effects 
of digitalis will greatly over-balance any possible evil ones. It 
is only necessary to add that the general amelioration of symp- 
toms caused by it is much the same as in the case of mitral 
1 egurgitation. 

Diseases of the Tricuspid Valve. — In both tricuspid constric- 
tion and insufficiency digitalis is of service in the same manner 
as in mitral disease, and it has been found particularly useful 
in cases of regurgitation with dilated right ventricle. As a 
rule, however, it does not appear to be as beneficial in tricuspid 
affections as in those of the mitral valve. As in the case of the 
latter, the rational signs furnish, for the most part, clearer 
indications for the use of digitalis than the physical. Thus, it 
is indicated when the cardiac action is rapid and feeble and the 
tension of the pulse low, and when there are cough, dyspnoea, 
pulsating jugulars, duskiness of the countenance, scanty, high- 
colored urine, and general dropsy. 

Diseases of the Aortic Valve. — There is a considerable diver- 
sity of opinion as to the advisability of giving digitalis in aortic 
disease. While, however, a few authorities assert that its dis- 
advantages are more than offset by its advantages, there can 
be but little question that in uncomplicated aortic regurgitation 
the drug is injurious, rather than beneficial. It increases the 
work of the heart, and the prolonged diastole caused by it 



DIGITALIS. 265 

favors the return of blood through the imperfectly closed orifice 
and exposes the ventricular wall to excessive strain; so that 
there is danger of syncope. In aortic stenosis, before com- 
pensatory hypertrophy has occurred, it may sometimes be of 
service. There is more or less obstruction to the normal 
flow of blood out of the heart, and digitalis will increase the 
ventricular force, so that it may overcome the difficulty. 
After the impediment to the circulation caused by the valvular 
defect has been compensated by a sufficient amount of cardiac 
hypertrophy it is not only useless, but may give rise to serious 
and even fatal results. But when aortic constriction leads to 
mitral incompetence and regurgitation, it may be given with 
advantage. 

So also in aortic regurgitation, when the marked cardiac 
dilatation apt to be caused by the condition has given rise to 
mitral insufficiency, digitalis is of great value. There are other 
cases of aortic regurgitation in which benefit is likely to result 
from its use; namely, those in which there is considerable dila- 
tation of the left ventricle, perhaps of sudden onset, and in 
which the prominent symptoms will be found to be shortness of 
breath, precordial pain, and anxiety. While digitalis is gener- 
ally contra-indicated in aortic regurgitation, especially when 
the latter, as is often the case, accompanies aortic constriction, 
yet when the heart-muscle fails and the hypertrophy is not 
compensatory, it is useful in both aortic insufficiency and con- 
striction. In all cases of aortic valvular disease the effects of 
the drug should be very carefully watched. 

It has been well said that the indication for giving or with- 
holding digitalis in the treatment of valvular disease of the 
heart rests not so much upon the particular valvular lesion that 
is present as on the effects which have been produced by this 
upon the cardiac wall. A knowledge of the relation of the 
heart-muscle to the work required of it in any individual case 
is much more important, therefore, from a therapeutic point of 
view, than a recognition of the pathological condition of one 
or more of the valves. In general terms it may be stated that 



266 PHARMACOLOGY AND THERAPEUTICS. 

digitalis is of special value in all conditions in which dilatation 
of the heart cavities has been brought about by failure of the 
muscular wall as a result of valvular disease. 

Constriction of the peripheral vessels which, as has been seen, 
is one of the chief physiological effects of digitalis, is sometimes 
so marked as to interfere materially with the successful use of 
the remedy in cardiac affections. When this is the case it may 
be counteracted to a considerable extent by the simultaneous 
administration of drugs causing vaso-dilatation, such as the 
nitrites. Nitroglycerin is a very useful agent for relaxing the 
spasm, and as its effect lasts but a short time while that of the 
digitalis is prolonged, it should be given at much more frequent 
intervals than the latter. As digitalis acts very slowly and 
maintains its effect for a long time, it may be sufficient, after 
its primary effects have been obtained, to administer it only 
once a day, for the purpose of continuing its influence. 

Cardiac Disease Other Than Valvular. — In palpitation due to 
over-exertion or heart-strain and in cardiac dilatation and 
asthenia digitalis is of decided value. In the " irritable heart 
of soldiers," a condition associated with muscular weakness and 
supposed to be dependent upon exhaustion of the inhibitory 
nerves, it has been found better than any other remedy. When, 
however, cardiac hypertrophy has occurred it is of but little 
service. The same remarks apply to the case of those indi- 
viduals who have engaged to excess in athletic exercise and 
who are troubled with more or less shortness of breath, but 
without any appreciable valvular lesion of the heart. In 
these cases the apex is often found to be a little outside its nor- 
mal position. Digitalis is frequently prescribed in tachycardia 
(rapid heart), but if acceleration of the rhythm is the only 
symptom observed, other drugs, such as aconite, may generally 
be substituted for it with advantage. In functional derange- 
ments of the heart, usually the result of faulty digestion, char- 
acterized by irregularity and palpitation, digitalis is indicated 
and will prove of essential service if it can be given in such a 
way as not to disagree with the stomach. In many such sub- 



DIGITALIS. 267 

jects, however, on account of its liability to increase the indi- 
gestion, its administration is found impracticable, and the main 
reliance for relief of the condition must be placed on treatment 
directed to the dyspepsia on which it depends. In certain cases 
of the functional trouble met with in highly neurotic subjects 
it is of marked benefit, but in a large number of these it fails 
to give relief. It is of great value in the weakness of the heart 
resulting from typhoid and scarlet fevers, pneumonia, rheu- 
matism, pericarditis and other acute diseases, even if no 
valvular lesion is present. The beneficial action of the drug is 
seen in the increased efficiency of the contractions and in the 
prolonged diastole, which allows more time for the cardiac 
muscle to rest. In these cases its effect may often be increased 
by combining it with caffeine or ammonia. If the latter is 
used, 8 c.c. (2 fl. dr.) of the infusion of digitalis may be given, 
with .20 c.c. (3 fll) of stronger ammonia water, in a little 
water. It is often desirable to administer digitalis in combina- 
tion with iron; but when its fluid preparations are associated 
with salts of the latter the mixture is rendered inky by the ac- 
tion of the iron, on the tannic acid in the digitalis. This diffi- 
culty may be obviated by adding a little diluted phosphoric 
acid, which acts as a clarifying agent, or a pill may be used 
composed of powdered digitalis leaves and dried ferrous sul- 
phate. Digitalis is also useful as a stimulant in cardiac weak- 
ness resulting from such causes as haemorrhage, injury, poison- 
ing and shock. In cases of this kind, on account of the slow- 
ness of its action, it should be preceded by ammonia and alcohol 
if the symptoms are urgent; or its slowness of action may be 
overcome by administering it hypodermatically. For this pur- 
pose tincture of digitalis is preferable to digitalin on account of 
its being much less liable to produce local irritation. Digitalis 
is particularly indicated in poisoning by aconite, muscarine and 
the nitrites, to which, as regards action on the heart, it is the 
physiological antidote. In organic non-valvular diseases of 
the heart dependent on degeneration of the cardiac muscle it 
should be used with extreme caution, if at all; and in many 



268 PHARMACOLOGY AND THERAPEUTICS. 

such its effects are decidedly injurious. In fatty and other 
degenerations, such as those resulting from alcohol and from 
chronic nephritis, the muscle is not in a condition to respond to 
the stimulation of the drug, while the peripheral resistance is 
increased from the vascular constriction caused by its action. 
Under these circumstances it is possible that some of the degen- 
erated fibres may rupture. In dilatation of the right side of 
the heart associated with chronic disease of the lungs digitalis 
may sometimes prove of service, but this is the exception rather 
than the rule. In the palpitation which is often such a dis- 
tressing feature of phthisis it has been found useful. 

Bright's Disease. — In renal dropsy from acute desquamative 
nephritis (tubal nephritis) digitalis, given in the form of infu- 
sion, has been found of considerable value. While a number of 
days may elapse before much effect is produced, the flow of 
urine is sometimes enormous, and this fact is regarded by some 
authorities as going to show that digitalis has a direct action 
on the glomeruli of the kidney. Although it is not infrequently 
given in acute Bright's disease, however, it has been questioned 
whether, if it has the effect of causing dilatation of the renal 
arteries, it is proper to increase the circulation in any acutely 
inflamed organ. Furthermore, even in the early stages the 
arterial tension is somewhat raised, and it is undesirable to 
increase this. In chronic Bright's disease the arterial tension 
is still further increased, and as, in addition, digitalis is an un- 
certain diuretic where the heart is not affected, the drug is 
contra-indicated, especially in cases of chronic tubal nephritis 
uncomplicated by cardiac disease. Still another reason why it 
should not be employed is the fact that it retards the elimination 
of urea and the chlorides. In many cases of granular, con- 
tracted, or cirrhotic kidney, however, where the cardiac hyper- 
trophy induced has not succeeded in overcoming the peripheral 
resistance (and in consequence there has occurred dilatation of 
the left ventricle and of the mitral orifice, with resulting 
regurgitation), digitalis, acting in the same manner as in cases 
of mitral regurgitation without renal disease, renders efficient 



DIGITALIS. 269 

service. In this condition the well-known diuretic pill consist- 
ing of calomel, digitalis, and squill, .06 gm. (1 gr.) each, made 
up with extract of hyoscyamus, may be used. 

Exophthalmic Goitre. — It has been used to a considerable 
extent in this affection, but has proved an uncertain remedy. 
Even after a long course of it, the condition often remains un- 
improved. Still, it would seem to be worth trying, as it is said 
sometimes to be remarkably successful in controlling the symp- 
toms. It may be combined advantageously with iron, ergot 
and zinc bromide. Even in incurable cases the cardiac irregu- 
larities and the dilatation of the cervical vessels are sometimes 
ameliorated, while cases purely functional in character, in 
young subjects, have been reported to be cured by digitalis. 

Bronchitis and Pneumonia. — In chronic bronchitis with pro- 
fuse secretion it has been found of more or less service in 
diminishing the secretion and pulmonary congestion, and conse- 
quently the dyspnoea, sweating and progressive loss of strength 
caused by them. It is also sometimes serviceable in chronic 
bronchitis with interstitial pneumonia (fibroid lung), when ac- 
companied with dyspnoea, secondary dilatation of the right 
heart, and general anasarca. Here, in cases in which its action 
is satisfactory, it lessens the cough and expectoration, tones up 
the weakened and laboring heart, and reduces the oedema. In 
the second stage of acute pneumonia, in cases where the heart, 
with almost empty arteries, is laboring and unable to do its 
work properly, it has proved of very great value. In any form 
of pneumonia (whether adynamic or not) when the right heart 
is becoming unable to force the blood through pulmonic capil- 
laries which are compressed by the existing exudation, digitalis 
may be found extremely useful. In the bronchitis and broncho- 
pneumonia of children it may also prove beneficial. 

Scarlet Fever. — Some authorities recommend digitalis highly 
in this disease, in which it is claimed that it reduces the tem- 
perature and maintains the action of the kidneys; thus dimin- 
ishing the two principal sources of danger. From a teaspoon- 
ful to a tablespoonful (according to age) of the infusion may 
be given every two, three or four hours. 



27O PHARMACOLOGY AND THERAPEUTICS. 

In various adynamic fevers digitalis is sometimes of the 
greatest value in sustaining the heart's action during a crisis 
or period of special strain upon the organ. 

Alcoholism. — In chronic alcoholism digitalis, in moderate 
doses, may prove of service, on account of the stimulating effect 
of the agent on the circulation. As to its value in delirium 
tremens authorities differ. While some maintain that it is 
practically useless, others assert that excellent results may be 
obtained from it, especially in cases where the pulse is very 
weak and compressible. The rest and sleep which, it is claimed, 
follow its administration are believed to be due to the cardiac 
stimulation and increased flow of blood to the nerve-centres 
caused by it. While enormous doses of the drug — 15, c.c. 
( l / 2 fl. oz.) of the tincture being the usual dose — are generally 
tolerated in these cases, probably because by long habit the 
heart has become benumbed to the influence of stimulants, their 
use is not altogether unattended with danger. Some who be- 
lieve in the efficacy of digitalis in this condition regard these 
large doses as unnecessary, and also hold that the infusion is 
preferable to the tincture. Of the infusion it is advised that 
15 c.c, or one tablespoonful, be given every four hours. Digi- 
talis is sometimes given in the young and robust, with marked 
cerebral hyperemia, but it is probably more efficacious in pale 
subjects with a tendency to cyanosis, in whom there is cerebral 
anaemia, with effusion and oedema. As has been mentioned, 
there is a remarkable tolerance for digitalis in this affection, 
but since the use of the drug is occasionally followed by fatal 
results, it would seem to be the part of prudence to carefully 
select the cases in which it is employed and to avoid excessive 
doses. 

Spermatorrhoea. — Digitalis has decided value as an anaphro- 
disiac. It has been found that it is capable of temporarily but 
completely annulling the activity of the sexual organs, and it is 
therefore of service in preventing erections of the penis due to. 
local irritation, and also nocturnal seminal emissions and other 
effects of genital excitement. It is adapted to cases of sperma- 



DIGITALIS. 271 

torrhoea in which there is an atonic condition, shown by feeble 
erections, frequent emissions, and cold hands and feet (where 
it may advantageously be combined with ergot), and also to the 
spermatorrhoea of plethora. In the latter it is claimed that 
better results can be obtained from digitalis in combination 
with potassium bromide than from any other treatment. In this 
condition 15 c.c. { l / 2 fl. oz.) of infusion of digitalis, with 1.20 
gm. (20 gr.) of potassium bromide may be given night and 
morning for a week, and after that at night only. 

Hemorrhage. — Digitalis is occasionally prescribed as a 
haemostatic, but is unreliable because the increased blood-pres- 
sure to which it gives rise may excite still greater haemorrhage. 
While it causes constriction of the vessels, it also accelerates 
the flow of blood through them. It may sometimes prove use- 
ful, however, in haemorrhage from a large surface, as in the 
haemorrhagic diathesis and in pulmonary haemorrhage. It has 
been found of advantage in cases of haemorrhage in the first 
stage of pneumonia and in haemoptysis due to disease of the 
mitral valve. 

Uterus. — If, as seems to be the case, digitalis has the power 
of inducing uterine contractions, it would naturally be expected 
that it would be of service in haemorrhages of that organ. In 
practice it has been found in cases of menorrhagia that shortly 
after a large dose of the infusion has been taken severe pains 
resembling those of labor come on. There is a momentary 
profuse discharge of blood and clots, if the latter be present, 
and this is followed by arrest of the flow for hours. The drug 
is stated to be particularly advantageous in menorrhagia or 
metrorrhagia occurring in plethoric individuals and in cases 
where the haemorrhage is dependent upon mitral disease. Both 
mitral regurgitation and stenosis, by increasing the blood-pres- 
sure in the uterine veins, sometimes give rise to menorrhagia 
of a peculiarly obstinate kind. Digitalis has also been used 
successfully to arrest post-partum haemorrhage, but is much in- 
ferior to ergot in this regard. 

Antagonists. — Reference has already been incidentally made 



272 PHARMACOLOGY AND THERAPEUTICS. 

to the antagonism between digitalis and aconite and other 
drugs. Aconite, while it also slows the heart, does so by 
dilating the peripheral vessels and lowering the blood-pressure, 
and is a cardiac poison; directly lowering the action of the 
cardiac motor ganglia and thus weakening instead of strength- 
ening the pulsation. Aconite acts quickly and digitalis very 
slowly, and this interferes to some extent with the efficacy of 
the latter in poisoning by the former. Opium, aconite, mus- 
carine, lobelia, the nitrites and other agents antagonize some of 
the actions of digitalis, but the antagonism does not extend 
throughout the whole range of their effects. Saponin and 
senegin, to which it is closely allied, are considered to be most 
complete physiological antagonists to digitalis. Tannin is the 
chemical antidote. 

STROPHANTHUS. 

1. STROPHANTHUS.— Strophanthus. Dose, 0.065 gm. (65 mil- 
ligm.); 1 gr. 

Preparation. 
Tinctura Strophanthi. — Tincture of Strophantus. Dose, 
0.5 c.c.; 8 Til. 

2. STROPHANTHINUM.— Strophanthin. Dose, 0.0003 gm. (0.3 
milligm.); f fo gr. 

Action of Strophanthus. 

External. — It has no action on the skin, but causes marked 
irritation of mucous membranes. Locally strophanthin is an 
anaesthetic, rapid in action and durable in effect, but so irritating 
that its application to the eye, for instance, is liable to set up 
inflammation or even ulceration. 

Internal. G astro -intestinal Tract. — In small doses it pro- 
motes appetite and digestion, and in larger ones it does not 
ordinarily cause gastro-intestinal derangement. It is true that, 
as in the case of digitalis, vomiting and diarrhoea are sometimes 
occasioned by strophanthus, but it will generally be found that 
these disturbances result from preparations from which the fixed 



STROPHANTHUS. 273 

oil contained in the seeds has not been extracted. The tinct- 
ure, prepared from strophanthus kombe (pubescent variety), 
does not give rise to them; while fluidextracts made from this 
and other species cause digestive disturbances varying from 
simple inappetence, nausea and vomiting to abdominal pain and 
diarrhoea. Strophanthin, used hypodermatically, is not irritat- 
ing to the digestive tract. 

Muscles. — Strophanthus is essentially a muscle poison, as 
shown in experiments upon the frog with the African kombe 
arrow poison, which is made from the plant. Its first effect is 
to increase the tonicity of the muscular fibre, and when the 
muscle dies it does not go into relaxation, but passes directly 
from life into post-mortem rigidity. It occasions stiffness of 
the limbs and afterward complete loss of voluntary movement. 
Its influence is more generalized than that of digitalis, which, 
while acting on all the muscular tissue, has a more special ac- 
tion on the heart and the muscle of the arterial wall. The 
physiological as well as the toxic action of strophanthus are 
mainly exerted on both the heart and the voluntary muscles, so 
that when full effects are produced on the cardiac muscle the 
general muscular system is decidedly affected. In toxic doses 
it paralyzes muscular tissue, not through the nervous system, 
but by direct contact, and when contractility has once been 
destroyed by its action, no stimulus will reexcite it. 

Heart. — Strophanthus being believed to exert its action upon 
muscular tissue by direct contact through the blood, and the 
heart naturally receiving a much larger supply of blood in the 
same length of time than any other muscle, that organ is 
promptly and decidedly influenced by the drug. By proper 
regulation of the amount administered the heart may be acted 
upon while the muscles in general remain practically unaffected. 
In moderate doses strophanthus has the same effect on the heart 
as digitalis, stimulating the tonic contraction of the cardiac 
muscle, increasing the force of the ventricular systole, prolong- 
ing the diastole, lowering and regulating, the rhythm, and caus- 
ing a pronounced though slow rise in the arterial pressure by 
19 



274 PHARMACOLOGY AND THERAPEUTICS. 

the increased force in the cardiac contractions. While some 
authorities deny that it acts on the pneumogastric like digitalis, 
and others assert that it has a similar influence on the inhibitory 
mechanism, there can be no question that it does have the effect 
of slowing the rate of the beat. Apparently this is a result 
of its direct cardiac action. If it has any influence at all upon 
the innervation of the heart, this would seem to be but tem- 
porary. In large amounts the drug paralyzes the heart, leaving 
its muscle completely rigid for the reason given above. 

Vessels. — The latest researches show that strophanthus, 
through its characteristic action on all muscular tissue, includ- 
ing that in the arterial walls, has a decided influence upon the 
vaso-motor system; but the constriction of the peripheral ves- 
sels due to it is considerably less marked than that caused by 
digitalis. This is the most important point of difference be- 
tween the two agents. Under the effect of digitalis, which 
powerfully contracts the vessels, and thus occasions a greater 
rise of blood-pressure than strophanthus, the work of the heart 
is much increased by the resulting resistance, and for this rea- 
son the latter is the safer remedy of the two. 

Kidneys. — Strophanthus is an efficient diuretic, increasing the 
quantity of urine not only in cases of cardiac disease, but also 
in healthy men and animals, and this diuretic influence is 
apparently exerted not only through the increased force of the 
heart and the effect on the circulation caused by it, but also 
through direct action upon the secreting structure of the kid- 
neys. The correctness of this view seems to have been con- 
firmed by the renal lesions observed in poisoning by strophan- 
thus and by oncometric experiments indicating that it produces 
no marked congestion of the kidneys. 

Nervous System. — As has been stated, the pronounced effects 
which it has upon the heart and muscles are in all probability 
due solely to its direct action by contact, through the blood, and 
not through the agency of any influence it exerts upon the 
nervous system. On the latter, so far as known, it has no 
action. 



STROPHANTHUS. 275 

Respiration. — Strophanthus appears to have no action on 
the respiratory centres. In experiments upon frogs it was 
found that the respiration continued for some length of time 
after the heart stopped, and the conclusion that the cessation of 
respiration was due to muscular influence was reached. 

Temperature. — It is antipyretic within a limited range, be- 
cause under its administration the consumption of oxygen is 
smaller and the processes of combustion are depressed. 

Absorption and Elimination. — Since its active principle is 
soluble in less than its own weight of water, strophanthus 
possesses the diffusibility of a soluble crystalloid; hence the 
prompt results from its administration. Again, its active prin- 
ciple escapes with the urine, so that we also have ready elimi- 
nation. This, however, is somewhat slower than its absorption, 
and there is, therefore, an overlapping of effect from too fre- 
quently repeated doses. Habit does not seem to impair the 
therapeutic usefulness of the drug. 

Therapeutics of Strophanthus. 
Having the same general effects, strophanthus is employed 
to fulfil the same indications as digitalis. On the heart it acts 
more promptly, though probably less permanently than the 
latter. As the indication is generally as much to diminish the 
resistance to the heart as to increase the amount of work which 
the organ is capable of doing, strophanthus has the great advan- 
tage over digitalis of not greatly constricting the arterioles. 
If, therefore, the heart is feeble and the arterial tension high ; 
strophanthus is decidedly to be preferred, unless some agent, 
like nitroglycerin, which has the effect of causing dilatation of 
the peripheral vessels should be given in connection with the 
digitalis. In those cases where digitalis does harm by so over- 
stimulating the ventricle that the auricle cannot thoroughly 
empty itself, and hence becomes congested, strophanthus is 
sometimes of the greatest service. Where extensive degenera- 
tion of the arterial coats is present, so that the increased pres- 
sure in the interior of the vessels may lead to rupture of their 



276 PHARMACOLOGY AND THERAPEUTICS. 

walls, strophanthus, as causing a less extensive rise in the 
blood-pressure than digitalis, should be employed if the admin- 
istration of a cardiac stimulant is called for. Its superiority 
as a diuretic renders it particularly valuable in oedema of the 
lungs or cases of general cardiac dropsy. It is often given 
advantageously in combination with digitalis, especially where 
free diuresis is desired, and is also much relied upon to take 
the place of the latter where its administration has to be sus- 
pended either on account of gastric irritation or for the pre- 
vention of cumulative effects. It is of great value in the car- 
diac diseases of children, in which digitalis is very apt to fail, 
and excellent results may also be obtained with it in corpulent 
individuals. Of especial importance should be considered its 
administration for the weak hearts of anaemia and chlorosis, in 
order that nutrition may be improved; for so-called irritable 
hearts, where the pain and palpitation are relieved; for de- 
bilitated hearts, associated with dyspeptic symptoms, and par- 
ticularly flatulence (which usually disappears) ; and in the aged 
when there is vertigo as the result of cerebral anaemia. It is also 
said to be particularly useful in the progressive heart-failure 
of elderly patients, with attacks of dyspnoea simulating angina. 
The advantages which strophanthus possesses over digitalis 
may be summoned up as (1) greater rapidity, modifying the 
pulse-rate within an hour; (2) less marked vaso-constrictor 
effects; (3) greater diuretic powers; (4) no disturbance of 
digestion from properly made preparations; (5) absence of so- 
called cumulation; (6) greater value in children; and (7) 
greater safety in the aged. 

The therapeutic indications for the use of strophanthus are, 
then: (1) Rapidly recurring cardiac systoles of lessened force 
and irregular rhythm. We get, first, a more vigorous con- 
traction of the ventricle, with a slowing of the pulse-rate and 
consequently a lengthening of the diastole, which is the period 
of rest for the heart; next comes the disappearance of irregu- 
larity of rhythm; and, lastly, from improved intracardiac 
nutrition, a permanent strengthening of the heart-muscle. (2) 



STROPHANTHUS. 277 

The comparative insignificance of its vaso-motor effects enables 
us to use this remedy in those instances of permanent high 
tension which are met with in some forms of Bright's disease, 
in arterio-sclerosis, and in the rigid arteries of the aged. (3) 
Whenever diuresis can be promoted by increased blood-tension 
resulting from more vigorous cardiac contractions this may be 
expected from the use of this remedy. (4) The rapidly ap- 
pearing effects of its administration, together with its regular 
elimination, make it the drug of choice when the symptoms are 
urgent. (5) The absence of digestive disturbances from ther- 
apeutic doses and slight likelihood of habituation to its admin- 
istration make it important when long-continued use is neces- 
sary. It should, therefore, be the remedy of choice in all cases, 

(1) in which we wish to establish compensation; (2) of arter- 
ial degeneration in which a remedy which causes more ener- 
getic cardiac contraction is required; (3) of cardiac disease 
when a diuretic is necessary; (4) of weak or irritable hearts; 
(5) of cardiac disease in childhood or old age. 

The instances in which failure will follow its administration 
are those of (1) advanced degeneration of the myocardium; 

(2) extreme mechanical obstruction to the circulation from 
valvular incompetency or obstruction; and (3) a combination 
of these. It will readily be understood that in fully com- 
pensated hearts this — as well as other drugs of the same type — 
is unnecessary, and when over-compensation exists it will likely 
aggravate the condition. It may be said, therefore, that success 
in the administration of strophanthus requires: I. An active, 
well-made preparation from a reliable source. 2. Avoidance of 
its use in fully or over-compensated hearts and in those which 
present advanced muscular degeneration or mechanical defects 
of high degree. 3. The use of not too large or too frequently 
repeated doses. Careful observation has shown that the dose 
of 0.30 c.c. (5 HI) of a reliable tincture three or, possibly, four 
times a day is sufficient. 

Strophanthus has been found of service in exophthalmic 
goitre, and, administered in combination with hoang-nan, it 



27 8 PHARMACOLOGY AND THERAPEUTICS. 

has also given good results in psoriasis, especially in cases at- 
tended with marked congestion of the integument. 

ADONIDIN. 

ADONIDINUM.— Adonidin (not official). Dose, 0.01 to 0.02 gm.; 
% to y 3 gr. 

Action of Adonidin. 
Adonidin has the same physiological action as digitalis, and 
produces its effects more promptly than the latter. In the frog- 
it causes tonic contraction of the heart and slows the pulse-rate. 
It increases the force of the systole, and finally produces arrest. 
In mammals it slows and strengthens the heart's action, and 
whilst diminishing the pulse-rate, very markedly increases the 
arterial pressure. It raises the general vascular tension by 
causing constriction of the arterioles, but the contraction is not 
so persistent as under the use of digitalis. The slowing of the 
rate is no doubt due to stimulation of the inhibitory nerves, 
since it is prevented by their previous section, while the rise 
in arterial pressure is chiefly attributable to the direct action of 
the drug on the heart. Under the continuance of full doses the 
primary rise is followed by a marked depression, and this late 
fall is believed to be the result, at least in great part, of vaso- 
motor paralysis. In toxic doses it is found to paralyze the 
terminals of the pneumogastric, excite the accelerator apparatus 
of the heart, and finally cause paralysis of the cardiac motor 
nerves. Adonidin renders the respiratory movements more 
full and less frequent. It also probably increases the flow of 
urine, its diuretic action being due to its effect on the circula- 
tion rather than to any direct influence on the secreting struct- 
ure of the kidneys. In many subjects it seems to cause more or 
less nausea, vomiting and purging. It is rapidly eliminated 
from the system, and therefore does not appear to have any 
cumulative tendency. 



SQUILL. 279 

Therapeutics of Adonidin. 
It is used for the same kinds of cases as digitalis. It has been 
found less certainly beneficial than the latter in valvular disease 
of the heart, but may prove a satisfactory substitute for it in 
cases in which that drug fails or is not well borne. As its action 
is more prompt, adonidin sometimes serves a useful purpose in 
beginning the regulation of the cardiac movements before digi- 
talis has had time to produce its effect. In addition to cases of 
organic disease, it has been found of service in functional 
irregularity, and especially in palpitation without any lesion of 
the heart. In combination with the bromides it is also said to be 
used with success in the treatment of epilepsy. The irritating 
properties of this drug prevent its subcutaneous use, and even 
prolonged administration by the mouth. 

SQUILL. 
SCILLA.— Squill. Dose, 0.125 gm. (125 milligm.) ; 2 gr. 

Preparations. 

1. Acetum Scillae. — Vinegar of Squill. Dose, 1 c.c; 15 TT\.. 

2. Fluidextractum Scillae. — Fluidextract of Squill. Dose, 0.1 
c.c; 1% Til. 

3. Syrupus Scillae. — Syrup of Squill. Dose, 2 c.c; 30 Til. 

4. Syrupus Scillae Compositus. — Compound Syrup of Squill. 
(Hive Syrup.) Dose, 2 c.c; 30 Til. 

5. Tinctura Scillae. — Tincture of Squill. Dose, 1 c.c; 15 tt\.. 

Action of Squill. 
The application of squill to the external integument is capable 
of producing the characteristic effects of the drug on the system. 
It affects the heart and arterial system in the same manner as 
digitalis, but its action on the heart, and especially on the periph- 
eral vessels, is less marked and decidedly less persistent than 
that of digitalis. The increased arterial pressure caused by it 
is due, it is believed, partly to the augmented cardiac force 
and partly to a peripherally produced vaso-motor contraction. 



280 PHARMACOLOGY AND THERAPEUTICS. 

It is a much more violent gastro-intestinal irritant than digi- 
talis ; causing, in sufficient doses, marked abdominal pain, vomit- 
ing, purging, and even fatal gastro-enteritis. Even small doses 
are liable to cause nausea. Another pronounced action of 
squill is that of an expectorant, and this, like its effect to a 
great extent on the gastro-intestinal tract, is probably produced 
during excretion. In passing through the bronchial mucous 
membrane it sets up an irritation which stimulates the blood- 
vessels of the part, and thus increases the functional activity oi 
the membrane. In addition to these actions, it is an efficient 
diuretic, promoting the activity of the renal circulation, and 
largely increasing the watery portion of the urine. It is stimu- 
lating to the kidneys, and in excessive doses gives rise to such 
an amount of irritation as to cause strangury and diminished 
secretion, the urine often being bloody and albuminous. The 
renal inflammation may even be so violent as to result in com- 
plete suppression. 

Therapeutics of Squill. 
Squill has been called the " harsh digitalis." In cardiac dis- 
ease, with or without dropsy, it is not prescribed alone, as 
digitalis, strophanthus and other heart stimulants are more effi- 
cient, as well as less toxic, in their effects. It may, however, be 
combined with digitalis with advantage, especially in dropsical 
cases, and a very favorite diuretic pill is composed of squill, 
digitalis and calomel, .06 gm. (1 gr.) each, made up with ex- 
tract of hyoscyamus, .09 gm. (1^ gr.)- This is sometimes 
known as Guy's triplex pill. Squill was formerly much in 
vogue in the treatment of renal dropsy, but is now rarely or 
never employed in cases of this kind, on account of its irritating 
effect upon the kidneys. It is valuable in dropsy not dependent 
on renal disease when the system is in an atonic condition, and 
it has been found of service, especially in combination with 
calomel, in serous effusion into the pleura and the pericar- 
dium resulting from chronic inflammation of the parts. When 
the stomach is intolerant of the drug, it may be sdmin- 



CONVALLARIA. 28 1 

istered by rubbing its tincture, with that of digitalis, into the 
skin, or by applying compresses saturated with these to the 
abdomen, and covering them with an impermeable dressing. 
Squill is principally used, however, in subacute and chronic 
bronchitis and emphysema, and, given in suitable doses and in 
connection with other appropriate drugs, is a most valuable 
remedy. It is more particularly indicated when the sputa are 
tenacious and coughed up with difficulty, and it is therefore 
desirable to employ with it an agent which increases the expira- 
tory force. As a stimulating expectorant, it is especially useful 
in the second stage of bronchitis, when secretion is scanty or so 
excessive as to need proper stimulation of the mucous mem- 
brane to bring on a healthy action. It should not be given in 
cases of phthisis or other chronic disease where there is any 
gastric irritation. Neither the syrup nor the vinegar of 
squill should be prescribed with ammonium carbonate, as the 
latter is incompatible with acetic acid, which is contained in 
both these preparations. 

CONVALLARIA. 

CONVALLARIA.— Convallaria. (Lily of the Valley.) Dose, 0.500 
gm. (500 milligm.) ; 7V 2 gr. 

Preparation. 
Fluidextractum Convallariae. — Fluidextract of Convallaria. 
Dose, 0.5 c.c; 8 Ttl. 

Action of Convallaria. 
In moderate doses convallaria has been found to at first slow 
the heart and raise the arterial tension, while subsequently the 
pulse is somewhat quickened. Section of the pneumogastric 
does not interfere with these actions. At the same time that the 
heart is thus affected, respiration is deepened and to some ex- 
tent slowed. It is a decided cathartic, increasing peristalsis and 
having an action on the bowels intermediate between those of 
scammony and aloes. It also acts to some extent on the kidneys. 



282 PHARMACOLOGY AND THERAPEUTICS. 

Under toxic doses the respiratory movements become very full 
and slow, the reflex function of the cord is abolished, and the 
heart is paralyzed. Death is caused by the direct action of the 
drug on the heart. It appears to have no cumulative action. 

Therapeutics of Convallaria. 
Convallaria has been used extensively in the same range of 
cases as digitalis. It is said to act more powerfully upon the 
right heart than the latter, but this is probably not true. The 
reports of the results of its employment in cardiac disease, how- 
ever, have been by no means uniformly favorable, and a more 
extended experience seems to indicate that this drug is very 
unreliable. It is, however, free from most of the undesirable 
effects of digitalis, to which reference has been made, and in 
dropsical cases especially it has sometimes proved of service. 
Some writers assert that it is particularly useful in cases of 
arhythmia and " cardiac hurry." At the present time con- 
vallaria is employed very little. 

CAFFEINE. 
CAFFEINA.— Caffeine. (Theine. Guaranine.) Dose, 0.065 gm. 
(65 milligm.); 1 gr. 

Preparations. 

1. Caffeina Citrata. — Citrated Caffeine. Dose, 0.125 gm. 
(125 milligm.); 2 gr. 

2. Caffeina Citrata Effervescens. — Effervescent Citrated Caf- 
feine. Dose, 4 gm.; 60 gr. 

3. Pulvis Acetanilidi Compositus. — Compound Acetanilide 
Powder. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Unofficial Preparations. 
Caffeinae Sodio-Benzoas. — Caffeine Sodium Benzoate. Dose, 
0.125 to 0.60 gm.; 2 to 10 gr. 

Caffeinae Sodio-Salicylas. — Caffeine Sodium Salicylate 
Dose, 0.125 to 0.60 gm.; 2 to 10 gr. 



CAFFEINE. 283 

Action of Caffeine. 

External. — Roasted coffee, especially in the form of powder, 
appears to have some disinfecting and deodorizing power. 

Internal. Alimentary Canal. — Coffee in small amounts is a 
stomachic tonic, and generally has a somewhat laxative effect; 
increasing (probably by reason of its volatile oils) the peristaltic 
movements of the intestine. The so-called biliousness sometimes 
caused by its habitual use is probably occasioned by the em- 
pyreumatic oil, caffeol or caffeone, which is one of its constitu- 
ents and which, if taken alone, is likely to disorder the diges- 
tion. The excessive use of both tea and coffee is liable to give 
rise to indigestion, acidity and heart-burn. Such use of tea is 
more prone than that of coffee to produce injurious effects in 
the alimentary canal, as well as elsewhere, partly perhaps be- 
cause, as a rule, more of the former than of the latter is con- \ 
sumed, and also because the effects of the continued action of 
the tannin in the tea are no doubt even more deleterious than 
those of caffeine. They not infrequently induce chronic con- 
stipation and cause very serious interference with digestion. 
The teeth of tea-tasters are very liable to decay. 

Heart. — From recent careful experiments on the dog's heart 
the effect of caffeine appears to consist in (1) an acceleration 
of the rhythm without further change; (2) a shortening of the 
movements, commencing in the auricle and spreading to the 
ventricle; and, in large doses, (3) auriculo-ventricular arhyth- 
mia, terminating in fibrillary contractions of the auricle, and 
finally of the ventricle. The primary acceleration would seem 
to be due to stimulation of the most irritable part of the heart, 
the so-called excito-motor apparatus, and as no further change 
in the movements is seen, the action of the drug at this stage 
appears to be confined to this area. The second change may 
be due in part to the acceleration, and thus be considered a 
secondary effect of the increased irritability of the excito-motor 
area; but it may also be ascribed, it is thought, to the action 
of the caffeine on the muscle of the auricle and ventricle, and 
may thus indicate that the influence of the drug has extended 



284 PHARMACOLOGY AND THERAPEUTICS. 

to these less susceptible parts of the heart. The third stage, that 
of arhythmia, is believed to be due to the ventricular irritability 
having been so greatly increased as to give rise to an idioventri- 
cular rhythm. The interference of the two rhythms then ex- 
plains the major part of the variation in the strength of systole 
and the extent of diastole. The idioventricular rhythm indi- 
cates that the characteristic stimulant action on the cardiac 
muscle has extended to the ventricle. When this has attained 
a sufficient height it leads to fibrillary contractions in the ven- 
tricle ; the previous appearance of these in the auricle appearing 
to indicate that the stimulant influence spreads to this before 
it reaches the ventricle. The action of caffeine on the mamma- 
lian heart thus appears to consist in a descending stimulation, 
which begins in the excitomotor area at the junction of the 
auricle and great veins, and extends into the auricles and finally 
to the ventricles. The effects can be explained by direct action 
on the muscle, without the necessity of appealing to any ner- 
vous apparatus, and these experiments do not support the idea 
that the nervous apparatus of the heart is involved in the effects. 
Comparing the action of caffeine on the dog's heart with that 
of digitalis, it is found that, as far as the direct action on the 
heart is concerned, they resemble each other in both affecting 
only the heart muscle. But while in the case of digitalis the 
earliest changes seen are in the strength of systole and extent 
of diastole in the ventricle and auricle, the stimulation exer- 
cised by caffeine begins in the excitomotor area and descends 
to the auricle and then to the ventricle, and its effects on the 
rhythm (as far as these are caused by direct action on the 
heart) are of secondary importance. Furthermore, the pri- 
mary changes induced by digitalis are not so much evidenced 
by increased irritability of the parts affected as by increased 
contractibility and lessened dilatation (increased tone), while 
there is no evidence of such a change in the late stages of 
caffeine poisoning, in which the ventricle is directly affected. 

Vessels. — Caffeine stimulates the vaso-motor centre, and 
under its influence the blood-vessels are therefore contracted, 



CAFFEINE. 285 

causing a marked rise in the arterial pressure. The muscle-fiore 

in the walls of the vessels, in common with the muscles in gen- 
eral, is also acted upon by the drug. Under small doses the 
constriction of the arteries, which is of comparatively short 
duration, is followed by an expansion of much longer duration, 
but with larger doses the subsequent dilatation does not occur. 
After repeated intravenous injection caffeine is found to fail 
to produce vascular dilatation, and soon each injection is fol- 
lowed only by vascular constriction. It has been demonstrated 
that the vaso-constriction caused by the drug is principally the 
result of central stimulation by the fact that this effect is very 
largely interfered with by chloral, which paralyzes the vaso- 
motor centre. That the rise of pressure is not due to increased 
cardiac energy is shown by its absence in preparations of the 
isolated mammalian heart. 

Muscles. — Small doses increase the excitability of the muscles,\ 
augmenting the quickness and force of their contraction. Under 
larger doses the height of the contraction of the muscle is less, 
the maximum load it is capable of lifting is smaller, and the 
muscle is exhausted by tetanus more quickly than a normal 
muscle. The contraction then becomes smaller and smaller, 
and the muscle gradually passes into rigor. In mammals much 
larger quantities of the drug are required to induce rigor than 
to paralyze the respiration. 

Respiration. — Respiration is quickened and strengthened by 
caffeine, which has a stimulating effect upon the respiratory 
centre in the medulla. This effect is shown in the improvement 
in the respiration caused by it in cases of poisoning by alcohol, 
opium and other drugs, but it is much less marked in the normal 
condition of the system. In toxic doses it produces first quicken- 
ing and then paralysis of the medullary centre. 

Nervous System. — Caffeine is a rapidly-acting stimulant to 
the cerebrum, medulla oblongata, and spinal cord. In its effect 
upon the cerebral centres the blood-supply would seem to bear 
an important part; it being probable that the circulation in 
the brain is affected indirectly by the changes produced in the 



286 PHARMACOLOGY AND THERAPEUTICS. 

general circulation. Any agent which causes general arterial 
constriction will tend to passively induce dilatation of the 
cerebral vessels, and hence it may be supposed that such dila- 
tation accompanies the general vaso-constriction due to the 
exhibition of caffeine. In the cerebrum the drug affects the 
psychic functions, and is without doubt the most certain and 
effective stimulant that we have to the nerve centres connected 
with the intellectual faculties. Consciousness is enjoyed to the 
fullest extent, all drowsiness is banished, and the highest mental 
powers have full play. The cerebral stimulation caused by it 
differs from that due to opium in that the reasoning faculty is 
not less affected than the imagination and in that the excitation 
is not incoordinate. Caffeine acts on the same parts as are 
first affected by alcohol and other agents of its class; but alters 
them in the opposite direction. They are the centres which are 
also first paralyzed, to some degree at least, by morphine and 
cannabis indica. Caffeine is therefore an efficient antidote for 
these, and especially for alcohol, since the medullary and spinal 
effects are also antagonistic. The sleeplessness often caused 
by tea and coffee is probably due in part to stimulation of the 
nerve centres and partly to the indirect effect of the dilatation 
of the cerebral blood-vessels caused by the constriction of the 
vessels of the body generally. In addition to tea and coffee, 
cocoa, coca, kola, guarana and the various other substances 
which have long been in use as beverages in different parts of 
the world all contain either caffeine or analogous alkaloids. 
They impart a sense of grateful refreshment, relieve fatigue, 
mental and muscular, and increase the capacity for physical 
exertion and endurance. The effect of caffeine on the acuteness 
of the senses is shown by the greater accuracy of touch under 
its influence. While the results of the drug taken in moderate 
quantity are of distinct benefit in intellectual work, larger 
amounts are apt to render connected thought more difficult, as 
impressions follow each other so rapidly that the attention 
becomes distracted. These larger doses often over-stimulate 
the cerebral circulation, causing pain and a sense of fullness 



CAFFEINE. 287 

in the head, restlessness and insomnia, with more or less con- 
fusion of mind, or even hallucinations and delirium. Sometimes 
tinnitus aurium and flashes of light before the eyes indicate 
derangement of the special senses. v'The pulse becomes rapid 
and irregular, and cardiac uneasiness or palpitation may occur; 
while in some instances convulsive movements of the hand 
and tremor in different parts of the body are noted. It is stated 
that such effects as these are induced only with difficulty in 
habitual tea or coffee drinkers; so that the continued use of 
small quantities of caffeine would seem to give rise to tolerance. 
Toxic doses, administered to animals, occasion rise of tem- 
perature, convulsions and general paralysis, but the temperature 
declines when paralysis supervenes. In the medulla, while 
caffeine has a marked stimulant effect on the activity of the 
vaso-motor and respiratory centres, it exerts practically no 
action on the vagus centre. In the spinal cord it excites reflex 
activity. It causes convulsions in the frog, and that these are 
not of cerebral origin is shown by the fact that section of the 
upper cord does not prevent them. On the other hand, destruc- 
tion of the cord does have the effect of preventing them, so 
that they are no doubt spinal. The effects of caffeine on the 
cord are reflex irritability, then tremors, and finally tetanus. 
They closely resemble those of strychnine, but are very much 
smaller, and occur only with relatively larger doses. This 
tetanus, which, like that of strychnine, is located in the cord, 
shows the same intermittent character and also involves the 
respiratory muscles in the same manner. It occurs both in 
mammals and frogs, but the dose required for the former is 
considerably larger than that necessary to give a vaso-motor, 
cardiac or diuretic effect. The motor nerves appear not to be 
affected by caffeine, but the sensory nerves are apparently 
slightly influenced by it. 

Kidneys. — Caffeine, in small doses, usually has a marked 
effect in increasing diuresis. It is a matter of common obser- 
vation that both tea and coffee augment the flow of urine to a 
much greater extent than the same amount of water, and this 



288 PHARMACOLOGY AND THERAPEUTICS. 

has been shown to be due to the caffeine which they contain. 
It was formerly supposed that the diuretic influence of this 
agent was principally owing, as in the case of digitalis, to an 
increase of cardiac energy which improved the renal circula- 
tion, but this is now known not to be so, since it has been shown 
that when changes in the circulation are prevented from taking 
place the same increased flow of urine occurs under its influ- 
ence. While the vascular expansion following the primary 
constriction of the vessels 'caused by small doses of the drug no 
doubt assists in the promotion of diuresis, the latter is mainly 
due to the direct action which it has in stimulating the renal 
epithelium. The increased activity of the secretory cells oc- 
casioned by it is also accompanied by a slight dilatation of the 
vessels of the part which is analogous to the vascular dilatation 
in a muscle undergoing contraction. But this tendency to pro- 
duce a dilatation of the renal vessels is always liable to be 
counteracted by the pronounced action of the caffeine on the 
vasomotor centre, which, on the other hand, tends to constrict 
the vessels. Such constriction has the effect of diminishing, 
and many even inhibit, the secretion of urine. Sometimes, 
therefore, it is found that the administration of caffeine not 
only produces no diuresis, but has the directly contrary effect; 
for if the contraction of the arterioles caused by it is great 
enough, the epithelial cells, however active they may be, can, 
owing to the interference with their blood-supply, secrete but 
little. Consequently, it will be seen that caffeine is by no 
means a certain diuretic, and in cases where it thus fails meas- 
ures must be taken which will prevent its action on the central 
nervous system. Under the diuretic effects of caffeine both the 
solids and the fluids in the urine are increased, but the former 
to a less extent than the latter. It is said that the excretion 
of alkalies, and especially sodium, is augmented even out of 
proportion to the diuresis. 

Metabolism. — The effect of caffeine upon tissue waste has 
been much investigated, with very contradictory results. Ac- 
cording to some of the latest and best authorities it causes a 



CAFFEINE. 289 

slight rise of temperature, partly by its action on the central 
nervous system, and more particularly by its direct muscular 
effects. In consequence of this, it is claimed, it also increases 
the metabolism, that is, the production of urea and carbon- 
dioxide. If this view is correct, the older one that it lessens 
metabolism is consequently erroneous. Caffeine is excreted in 
the urine in small quantities, but a considerable proportion of it 
is probably decomposed, with the formation of xanthin, which 
is further broken up into urea. 

Therapeutics of Caffeine. 
Heart. — As caffeine cannot be administered subcutaneously 
alone, owing to its decomposition in the presence of water, it 
is necessary, for this purpose, to combine it with sodium salicy- 
late or benzoate. The following solution will answer well for 
hypodermatic use: Caffeine, 40, sodium salicylate, 30, distilled 
water, 60 parts. In cardiac disease caffeine has been employed 
to a considerable extent as a substitute for digitalis, but as has 
been seen, its action on the heart is different from that of the 
latter and cannot, therefore, take its place. As a rapidly-acting 
cardiac stimulant it may prove of service in a variety of con- 
ditions, and in certain cases with feeble action of the heart it 
also does good by increasing the general blood-pressure, through 
its constricting influence on the arterioles, and thus producing 
a more efficient circulation. Its chief utility in heart affections, 
however, is in cases attended with dropsy, where by its marked 
diuretic action it proves highly efficacious in a considerable pro- 
portion of instances. It may often be combined with advantage 
with digitalis, strophanthus, or other drugs having a similar 
cardiac action. The preparations of caffeine are useful also 
when combined with antipyrine or acetanilide derivatives to 
counteract their depressing influence upon the heart, as in 
the official compound acetanilide powder given above. Caffeine 
sometimes causes so much insomnia that its use has to be dis- 
continued, and it is alleged that occasionally it sets up con- 
siderable smarting in the penis and even a mild form of ure- 



29O PHARMACOLOGY AND THERAPEUTICS. 

thritis. The nervous phenomena and the irregularity of the 
heart's action sometimes occasioned by tea and coffee are gen- 
erally recognized. 

Kidney. — The physiological action of the drug shows it to 
be within certain limitations a diuretic of great value. It is a 
fact worthy of note and to be borne carefully in mind in the 
therapeutic use of caffeine, that the diuresis is produced by 
smaller doses than those required for any other of its effects. 
This constitutes a point of great practical importance, for the 
smaller doses, while sufficient to bring about the desired effect 
on the kidneys, do not as a rule affect the central nervous sys- 
tem to such an extent as to cause the antagonistic vaso-constric- 
tion which so seriously interferes with the renal function. Even 
when given in the smallest supposedly effective dose, however, 
its effect upon the urine is somewhat variable, and in order to 
secure satisfactory diuresis it is therefore sometimes advisable 
to administer with it some such agent as chloral or paraldehyde 
which diminishes the excitability of the medullary centres. It 
should seldom or never be employed in acute inflammatory 
conditions of the kidney, because stimulants are contra-indi- 
cated when the part they influence is inflamed; but it is some- 
times of service in chronic Bright's disease, especially when 
there is marked cardiac failure. When, however, the secreting 
cells are in such a state as to be incapable of stimulation, it 
will naturally prove inefficient; so that in renal dropsy it may 
be said to be useful in inverse ratio to the amount of damage 
suffered by the kidneys. In simple cardiac dropsy, where it 
often acts so effectively, the epithelial structures are not dis- 
eased, but only passively congested. As a diuretic, caffeine is 
now regarded as decidedly inferior to theobromine, and the 
reasons alleged for this are: (1) because the diuresis is less 
certain and often accompanied by nervous symptoms such as 
restlessness and insomnia, and (2) because the secretion is 
smaller and lasts for a shorter time. Theobromine, while having 
an action similar to that of caffeine, has a much less pronounced 
effect upon the central nervous system. 



CAFFEINE. 29I 

Nervous System. — As a stimulant to the central nervous sys- 
tem, and especially to the respiratory centres, caffeine is of 
great service in cases of poisoning by opium and by alcohol. 
In the treatment of the former strong black coffee has long 
been in use, and caffeine might perhaps be substituted for it 
with benefit. Hot coffee, however, has the advantage of adding 
to the heat of the body, which is apt to be quite cold. It has 
been ascertained by experiment that within narrow limits there 
is a direct physiological antagonism between caffeine and 
morphine. In the insomnia of chronic alcoholism caffeine, in 
small doses given subcutaneously, has also been found useful. 
On the other hand, it is sometimes taken, in larger quantity, to 
produce wakefulness and increase the vigor of the mental 
powers during excessive use. So, in despondency and hypo- 
chondriasis and in neurasthenia it sometimes has a good effect. 
In migraine and other forms of nervous headache, such as 
hemicrania, with or without gastric derangement, it is much 
used. In this class of affections it is not so efficient as anti- 
pyrine; but it may often be advantageously combined with the 
latter, and, in addition, sometimes with one of the bromides. 
Some observers have also found it especially efficient when given 
in connection with phenacetine. If the headache is due, as is 
often the case, to errors of refraction, much benefit can hardly 
be expected from it. In trigeminal, cervico-brachial, and other 
neuralgias, particularly when given in combination with some 
of the coal-tar products, it often affords relief. Or, it may be 
administered alone hypodermatically. In the adynamia of 
typhoid and other acute fevers it may at times prove useful, 
either alone or as an adjuvant to alcoholic and other stimulants. 
In some forms of malarial fever it is claimed that strong coffee 
has a curative effect. One reason that caffeine, as sold in the 
markets, so frequently gives rise to the peculiar nervous and 
renal by-effects that it does is because theine made from the 
sweepings of the tea-houses is substituted for caffeine. 

Alimentary Tract. — Caffeine is a stomachic tonic, improving 
the appetite and digestion, and it has been found of service in 



292 PHARMACOLOGY AND THERAPEUTICS. 

convalescence from various acute diseases. In nervous dys- 
pepsias and in chronic catarrh of the stomach with occasional 
attacks of migraine it is often useful. So also in the diarrhoea 
of phthisis and of typhoid fever, and in ordinary atonic diar- 
rhoea, as well as in cholera infantum and in cholera morbus, 
especially when dependent on agencies affecting the nervous 
system. In affections of this character the sodium benzoate or 
the sodium salicylate, in combination with nux vomica or 
strychnine, may sometimes be used with advantage. 

Respiration. — In certain cases of asthma it is of value; the 
paroxysm being promptly relieved by it. In many instances, 
however, it has little or no beneficial effect. In pneumonia or 
in congestion of the lungs, with weak heart, in elderly in- 
dividuals, it sometimes proves of material service. 

Uterus. — The sodium benzoate has been recommended in 
puerperal haemorrhage, the statement being made that when 
given subcutaneously it acts more promptly than ergot. 

As the solubility of caffeine citrate is variable, caffeine is 
best given as such, but it is recommended that a dose of 
sodium salicylate half as large as that of the caffeine should 
be administered with it to insure the solution of the caffeine. 

GUARANA. 
GUARANA.— Guarana. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Guaranse. — Fluidextract of Guarana. Dose, 
2 c.c.; 30 TTt. 

Action of Guarana. 
Guarana is habitually used as a beverage by the South Amer- 
ican Indians who make it. Its effects on the system are mainly 
those of its alkaloid, although it contains sufficient tannic acid 
to have an appreciable influence. 

Therapeutics of Guarana. 
In medicine guarana is employed almost exclusively for the 
relief of headache. The forms of headache in which it is most 



COLA. 293 

serviceable are the nervous sick headache which recurs at short 
intervals, especially in women at the menstrual periods, and 
that which follows a debauch, when the head throbs and the 
eyes are bloodshot. In many instances, however, guarana, like 
most other remedies, gradually loses its power over such attacks, 
and may eventually aggravate them. In the headache of 
chlorosis guarana is said to be efficient in combination with 
cannabis indica. Almost the only other purpose for which the 
drug is now used is in the treatment of atonic chronic diarrhoea. 
By the Indians it is considered valuable in the prevention and 
cure of bowel complaints. 

COLA. 

COLA.— Cola (not official). Dose, 1 gm.; 15 gr. 

Action of Cola. 
It is somewhat stimulating to the digestion and is like coca 
in enabling the body to undergo unusual exercise without 
fatigue. Its effects on the nervous system appear to be much 
the same as those of caffeine. Partly in consequence of its 
increasing the force and frequency of the pulse, the blood 
tension rises and metabolism is carried on more rapidly. As 
it contains a larger proportion of theobromine, it is said to have 
a more pronounced diuretic action than caffeine. 

Therapeutics of Cola. 
It has been used in various phases of debility, including 
diarrhoeas in the debilitated, in irregularity of the heart's action, 
as a vehicle for the administration of cardiac stimulants, in 
migraine, and in neuralgia and other nervous disorders. It is no 
doubt of most benefit in diseases characterized by great nervous 
weakness and in convalescence from acute diseases in which 
wasting is pronounced, of which typhoid fever is the type. It 
has a marked effect in relieving the mental depression, while the 
diminution of the natural tendency to faintness, the disappear- 
ance of nervous irritability, and the acquisition of the ability to 



294 PHARMACOLOGY AND THERAPEUTICS. 

undergo muscular exertion, under its use, are well established 
facts. When fatiguing literary work or monotonous mental ap- 
plication is called for, kola probably affords greater assistance 
than any other drug. It may be of service in those occasional 
instances of morbid somnolence which can be definitely stated to 
be not dependent upon dyspepsia in its various forms, diabetes, 
lithsemia, gout, nervous exhaustion, or malarial disease. It is 
also of value in the performance of muscular feats, from the 
caffeine which it contains in a nascent condition. It is highly 
prized by the natives of equatorial Africa, who take it to enable 
them to endure long exertion without fatigue, and use it as a 
masticatory. It is also reputed to render bad water palatable 
and tainted meat palatable. The most effective manner of em- 
ploying the drug is said to be by slow mastication and swallow- 
ing the saliva. 

ERYTHROPHLOEUM. 

ERYTHROPHLCEUM. — Erythrophloeum (not official). (Sassy 
Bark.) 

Unofficial Preparation. 
Tinctura Erythrophloei. — Tincture of Erythrophloeum. Dose, 
0.30 to 0.60 c.c; 5 to 10 Til.. 

ERYTHROPHLCEINA. — Erythrophlceine (not official). Dose, 
0.0015 to 0.0020 gin.; ^ to ^ gr. 

Action of Erythrophlceum. . 
Under its influence the heart is at first slowed; later its action 
becomes rapid. The ventricles contract regularly and stop in 
systole, while the auricles may continue to beat. This slowing 
is remarkable (i) from the regularity and energy of the sys- 
toles, and (2) from the fact that during the slowing the uni- 
form blood-pressure is not altered by respiratory movements. 
The blood-pressure rises because (1) of the increased energy of 
the heart and (2) of the contraction of the blood-vessels; this 
condition persists until the heart becomes irregular, when it 
falls. The respiratory movements are at first slower and fuller, 
but when the heart grows feeble they become accelerated, and 



ERYTHOPHLCEUM. 295 

during the period of weak and irregular cardiac action produce 
the so-called respiratory oscillations in blood-pressure. Moder- 
ate amounts increase diuresis; larger doses produce vomiting 
and increased peristalsis; poisonous doses induce convulsions, 
later, marked weakness of all muscles, and, finally, death. The 
mode of action may be summed up as that of a muscle-poison 
acting primarily upon the heart for the reason that the latter 
receives a larger quantity of poisoned blood. Still, its sphere 
of influence appears to be the inhibitory, rather than the muscu- 
lar system, and upon the vagus its action resembles that of 
digitalis. It is a vaso-constrictor by acting on the vessels them- 
selves, on the vaso-motor nerves, or on some vaso-motor centre 
not in the medulla, but probably in or around the vessels them- 
selves. The respiration is influenced through the pulmonary 
branches of the vagus. Erythrophlceum is a sternutatory because 
the powdered bark is irritant to the nasal mucous membrane, 
it causes vomiting by reason of its solutions possessing the same 
property, and it is diuretic for the same reason and under the 
same conditions as digitalis. Its ability to slow the heart is 
rather greater than that of digitalis, but it is more decidedly a 
gastric irritant. Its vaso-constrictor properties are practically 
those of digitalis and ergot combined. It is rather less cumu- 
lative than digitalis ; using this term in the same sense in which 
it is applied to the latter. 

The alkaloid is locally anaesthetic, but although the anaesthetic 
condition induced by it lasts several hours, practically it is in- 
ferior to cocaine, since it dims the cornea and causes myosis, 
headache, giddiness and even syncope. Its employment for this 
purpose has therefore been abandoned. 

Therapeutics of Erythrophlceum. 
The field of use for erythrophlceum, of which a 10 per cent, 
tincture has been recommended in dose of from .30 to .60 c.c. 
(5 to 10 HI), by the British Pharmaceutical Conference, would 
seem to be limited to the heart and blood-vessels in cardiac dis- 
ease whether accompanied by dropsy or not. The indications 



296 .PHARMACOLOGY AND THERAPEUTICS. 

for its employment are identical with those for digitalis. As 
to constancy of effect in slowing the heart, strengthening the 
pulse, and promoting diuresis, digitalis is rather more reliable. 
The use of this remedy should, then, be confined to those cases 
of fairly competent heart with low vascular tension in which 
it will show its effects more rapidly and markedly, and to those 
cases in which digitalis has lost its usefulness or has utterly 
failed. 

CAMPHOR. 

1. CAMPHORA.— Camphor. Dose, 0.125 gm. (125 milligm.) ; 
2 gr. 

Preparations. 

1. Linimentum Camphorae. — Camphor Liniment. (Camphor- 
ated Oil.) 

2. Ceratum Camphorae. — Camphor Cerate. 

3. Aqua Camphorae. — Camphor Water. Dose, 8 c.c; 2 fl. 
dr. 

4. Spiritus Camphorae. — Spirit of Camphor. Dose, 1 c.c; 
15 TTL. 

2. CAMPHORA MONOBROMATA. — Monobromated Camphor. 
Dose, 0.125 gm. (125 milligm.); 2 gr. 

3. ACIDUM CAMPHORICUM.— Camphoric Acid. Dose, 1 gm.; 
15 gr. 

Action of Camphor. 

External. — Like the volatile oils, camphor acts as an irritant 
to the skin and mucous membranes. It is a direct cutaneous 
stimulant, causing redness, itching and warmth, owing to a 
local dilatation of the vessels. Later this sense of warmth is 
followed by some degree of local anaesthesia from paralysis of 
the sensory nerves. On mucous membrane it produces similar 
irritation, as indicated by congestion and smarting. It has 
some antiseptic action, but this is considerably weaker than 
some of the substances of the phenol group, and also than 
many of the volatile oils. 

Internal. G astro-intestinal Tract. — In small doses it is 



CAMPHOR. 297 

stomachic and carminative, inducing a feeling of warmth and 
comfort in the stomach. Here, as on the cutaneous surface, it 
causes dilatation of the vessels, and thus has a mildly stimulat- 
ing effect on the secretion of gastric juice and on peristalsis. 
In larger amounts it may produce sufficient irritation to cause 
nausea and vomiting. In medicinal doses it has little action on 
the intestines themselves, but it exerts quite an efficient anti- 
septic influence in the bowel, as it is found that the amount of 
combined sulphates in the urine is diminished by it. 

Absorption and Excretion. — Camphor is absorbed with con- 
siderable rapidity from the stomach and intestine, as well as 
from the skin and the respiratory mucous membrane when in 
contact with them. After absorption it is converted into cam- 
phorol, a body in which one atom of H in camphor is replaced 
by OH, and this combines with glycuronic acid and is excreted 
in part in the urine as camphor-glycuronic acid. An amido- 
derivative of this acid is formed at the same time, and is also 
found in the urine. Camphorol acts like camphor, but its 
glycuronic combinations are inert, so that the effects of cam- 
phor are observed to pass off quickly in such animals as the 
dog, in which these combinations are rapidly formed. In ani- 
mals poisoned with camphor a considerable quantity of glucose 
is said to be frequently present in the urine. 

Blood. — It is said to increase the number of leucocytes in the 
blood. 

Heart and Circulation. — While the effects of camphor on the 
mammalian heart are as yet but very imperfectly known, it may 
be stated that the heart is generally slowed by the drug, while 
the contractions are at the same time greatly strengthened. 
This appears to be due rather to a direct stimulation of the 
cardiac muscle than to the influence of the regulating nerves. 
There may, however, be some slight reflex stimulation of the 
organ. On the normal heart camphor usually produces 
lengthening of the systole and shortening of the diastole, some- 
what after the manner of digitalis, and the pulse becomes fuller, 
stronger and slower. The blood-pressure may either rise or 



298 PHARMACOLOGY AND THERAPEUTICS. 

show alternate rise and fall. Such variations are found to 
persist after convulsive movements have been prevented by 
curara, and it is therefore believed that the rise is mainly caused 
by a stimulation of the vaso-motor centre, and that this stimula- 
tion is intermittent in character, since the variations mentioned 
are independent of the respiration. The stimulation of the 
heart and the reflexes, especially those arising from the stomach 
also, no doubt, contribute to the rise in blood-pressure. 

Respiration. — The respiration is usually but slightly affected, 
but as a rule becomes slower and deeper under large doses. 
Some observers find the rate as well as the volume increased 
by it. During the convulsions caused by camphor in animals 
the respiration is arrested, and in the intervals may be accel- 
erated in consequence of the muscular exertion during the 
spasms. Whether any excretion of the drug takes place by the 
lungs is not positively known, but the breath of persons using 
it sometimes smells of it, and it is thought probable that some 
camphor or some derivative from it is excreted by the bronchial 
mucous membrane, the vascularity and secretion of which is 
thus stimulated. It is generally regarded as an expectorant of 
somewhat feeble power. 

Nervous System. — The action of camphor on the central ner- 
vous system in mammals has been found to consist in stimula- 
tion, followed by paralysis of the cerebral areas and probably 
of other intracranial centres, with less marked effect on the 
spinal cord. As regards the brain the stimulant symptoms begin 
in man with excitement, impulsive movements, confusion and 
delirium with hallucinations, and these are followed by epilepti- 
form convulsions. In the lower animals the symptoms are simi- 
lar: wild excitement and epileptiform convulsions, followed by 
depression, stupor and collapse. The convulsions have generally 
been attributed to stimulation of the medulla oblongata, but the 
epileptiform character of the attacks points to an affection of 
the cerebral cortex, and experimenters have found that re- 
moval of the cortex prevented the convulsions in mammals, 
though in the pigeon convulsions continued after the cerebrum 



CAMPHOR. 299 

had been removed. On the whole, there seems to be good reason 
for supposing that these seizures have their origin, at least 
partly, in the higher areas of the nervous axis. The first evi- 
dence of stimulation of the medulla is vertigo. Later all the 
medullary centres are stimulated : the respiration is increased 
in volume, the blood-pressure rises, and the face and skin be- 
come flushed in consequence of the stimulation of the vaso- 
dilator centre. Under sufficiently large doses the medulla is 
paralyzed, and collapse ensues, with death from failure of the 
respiration. Sometimes, however, the respiration ceases during 
a convulsion, and fails to return when it passes off. In man the 
epileptiform convulsions alternate with intervals of quiet and un- 
consciousness, until the patient sinks into complete stupor; and 
in exceptional instances of poisoning there is no stage of ex- 
citement, the patient at once falling into a condition of drowsi- 
ness, unconsciousness and stupor. As regards the spinal cord, 
in mammals there is observed some stimulation, followed by 
paralysis, but this is unimportant and does not occur until late. 
In the frog, on the other hand, the spinal paralysis is found to 
be so pronounced as to entirely obscure any effect the drug may 
have upon the higher nervous centres. The reflexes, which do 
not seem to be much affected at first, later disappear, and the 
animal lies completely paralyzed. The susceptibility to the 
effects of camphor varies very greatly in different individuals. 
.30 to .60 gm. (5 to 10 gr.) will produce in some persons a con- 
siderable amount of exhilaration, while in others the only effect 
observed will be a sense of comfort and restfulness. 

Temperature. — In health the temperature is not affected, but 
in fever, camphor has, like many aromatic bodies, some anti- 
pyretic action. 

Muscles. — On the striped muscles of the frog, when directly 
exposed to its solutions or vapor, camphor has a curara-like 
action, weakening and paralyzing them; but this is not observed 
in mammals. In certain experiments, made with a Mosso's 
ergograph, the drug sometimes seemed greatly to increase the 
energy and endurance of human muscles, but in other instances 
failed to have any influence. 



300 PHARMACOLOGY AND THERAPEUTICS. 

Skin. — The fact that in those using camphor the sweat some- 
times smells strongly of the drug points to some excretion of it 
by the skin. It has a mild diaphoretic action, and this may be 
due in part to its effects on the central nervous system. 

Sexual Organs. — Occasionally camphor has the effect of in- 
ducing dysuria. In small doses it' sometimes appears to in- 
crease the sexual appetite; but any such effect is probably to be 
attributed merely to its general stimulant action on the circula- 
tion. In large doses it has been held by many to be anaphro- 
disiac. 

Therapeutics of Camphor. 

External. — On account of its stimulating properties, camphor 
is probably employed more extensively as an ingredient of lini- 
ments of various kinds than any other drug. Thus, as a mild 
irritant or counter-irritant it is rubbed into the skin, in one 
form or another, for the relief of internal inflammations, chronic 
inflammatory induration, chronic rheumatism, etc. In such 
conditions as myalgia, sciatica, lumbago and neuralgia of 
superficial nerves it also answers the same purpose, and in addi- 
tion, by its effect in inducing local anaesthesia, serves to allay 
the pain. Camphor and hydrated chloral triturated together 
form a clear liquid which will take up morphine, atropine and 
other alkaloids in considerable quantity, and such a solution can 
be mixed with chloroform without precipitation. The resulting 
mixture constitutes a topical application of great power in the 
treatment of pain and inflammation ; and it may be either painted 
on the affected part with a camel's-hair brush or applied on 
absorbent cotton or lint which is then covered with oiled silk. 
The official chloroform liniment is made of chloroform, 300; 
soap liniment (of which camphor is an ingredient), 700; and 
a Chloroformum Camphorse may be prepared by dissolving cam- 
phor, 2, in chloroform, 1. The liquid preparations of camphor 
with chloral, thymol and carbolic acid are excellent local 
anodynes for neuralgia, and may also be applied on cotton 
to the cavities of aching teeth. A warm flaxseed poultice to 
which camphor and morphine have been added is a good ex- 



CAMPHOR. 3OI 

ternal application for the relief of toothache. The solution of 
camphor in ether has been applied locally with benefit in ery- 
sipelas, and powdered camphor, freely sprinkled over the sur- 
face, is sometimes successful in preventing pitting of the face 
from small-pox. Powdered camphor has also been used with 
success upon specific ulcers of the genitals, and is an efficient 
application for indolent ulcers. For the latter the camphor oint- 
ment of the National Formulary (camphor, 22; white wax, 11; 
lard, 67) may likewise be employed. Camphor, 14, combines 
with salicylic acid, 1 1, with the aid of heat, and in the form 
of ointment has been used in chronic ulcers and in lupus. In 
chilblains ointments or liniments containing camphor are often 
useful. For chapping or roughness of the skin camphor may 
be employed in the form of Ceratum Camphorse or incorporated 
in suet or lanolin. Either alone or in combination with other 
agents it is of service in relieving the itching of eczema and 
other cutaneous affections. A combination of camphor, 3, and 
phenol, 1, is a valuable antiseptic and anodyne dressing 
for wounds, and on account of its anaesthetic properties is 
useful in the treatment of inverted toe-nail. It may also be 
locally applied with benefit in pharyngitis or tonsillitis, herpes, 
erysipelas, vaginitis, vulvitis and paresthesia of the vulva and 
other parts. It may likewise be used to overcome the fetor of 
lochial discharges. Fluids having valuable antiseptic powers 
are also formed from camphor with salol and with betanaphthol. 
Mixtures of camphor with menthol, of various strengths, are 
employed in acute nasal catarrh, pharyngitis and laryngitis, in 
hypertrophic rhinitis, and in diseases of the ear. The vapor of 
camphor is inhaled with some relief in coryza and also in 
some forms of headache. In the household the spirit or " eau 
sedative," applied on a handkerchief or a flannel bandage, is 
a popular remedy for headaches and various neuralgic pains. 
Camphor enters into the composition of many dentifrices. 

Internal. — Camphor is contra-indicated in inflammatory dis- 
eases of the gastro-intestinal mucous membranes It is much 
used as a carminative, particularly in neurotic individuals. A 



302 PHARMACOLOGY AND THERAPEUTICS. 

few drops of the spirit will often give relief in hysterical vomit- 
ing, and camphor water with compound tincture of lavender is 
an excellent remedy for flatulence, especially hysterical flatu- 
lence. With the addition of laudanum this mixture is very 
useful in ordinary diarrhoeas. Camphor in combination with 
opium is very largely used in the treatment of diarrhoea, and 
even in the preliminary diarrhoea of Asiatic cholera has fre- 
quently proved of the greatest service. Hope's camphor 
mixture, when freshly made with nitrous, rather than nitric, 
acid, is a useful preparation and is especially well adapted 
for diarrhoea of relaxation in elderly subjects. Either rhu- 
barb, capsicum, chloroform or some astringent is often added 
to the preparations of camphor and opium in diarrhoea 
mixtures. Camphor is very commonly used for aborting 
colds and in the treatment of cold in the head. A very 
good "cold powder" consists of camphor (dissolved in 
ether), 5; ammonium carbonate, 4; powdered opium, 1. The 
dose of it ranges from .20 to .60 gm. (3 to 10 gr.). It has been 
found of value in breaking up colds when taken in time, and in 
modifying their force when taken later. For the treatment of 
acute coryza an excellent combination consists of camphor, 
quinine and fluidextract of belladonna, administered in pill or 
tablet. As camphor tends to allay cough and promote expec- 
toration, it is a common ingredient of cough mixtures and is 
much employed in the form of paregoric. Camphor is used 
especially in chronic bronchitis, emphysema, and capillary 
bronchitis. It has also been found of service as a stimulant 
in so-called typhoid pneumonia. It was formerly employed 
to a considerable extent in the treatment of asthma, but has 
now been superseded by other remedies which have proved more 
efficient. Administered with spirit of chloroform and compound 
tincture of lavender, spirit of camphor has been given with ad- 
vantage in influenza. In typhus and typhoid fever and in the 
exanthemata generally it has long been used as a cardiac stimu- 
lant and also for the purpose of quieting delirium, subsultus or 
restlessness. In Tokio, Japan, excellent results have been re- 



CAMPHOR. 3O3 

ported from the use of camphor, to the exclusion of other 
medication, in the treatment of typhoid fever, the observations 
extending over a period of five years. The regular amount 
administered daily was 1 gm. (15 gr.). In senile gangrene 
and hospital grangrene large doses of camphor have proved of 
value, while the powdered drug has been applied with advantage 
to the sloughing surfaces. According to some authorities, 
2 gm. (30 gr.) a day may be given hypodermatically (in the 
form of a 10 per cent, solution of olive oil) in the profound 
adynamia of acute endocarditis, typhoid fever, pneumonia, etc., 
with the happiest result. It is stated that the addition of a 
few drops of camphor to a small enema of ordinary water will 
produce a prompt evacuation of .the bowels. A elyster of cam- 
phor is also an effective remedy against thread-worms. The 
use of large doses of camphor in abnormal sexual excitement 
and in chordee, as well as in severe convulsive disorders such 
as whooping-cough, epilepsy and puerperal convulsions, has to 
a large extent passed out of vogue, though monobromated cam- 
phor is still employed in some of these conditions. A full 
dose of camphor is sometimes given to arrest the strangury 
produced by cantharides used for blistering. Combined with 
opium it has been quite generally employed, in the form of 
suppositories, after operations upon the urethra, etc., though at 
the present time surgeons are inclined to entirely dispense with 
the use of narcotics and anodynes both before and after such 
operations. Suppositories of this kind are found of service, 
however, in cystitis, enlarged prostate, and other affections of 
the genito-urinary organs. Camphor is a common remedy in 
attacks of nervousness and hysteria, and in hysterical convul- 
sions is a useful antispasmodic. In some cases of delirium 
tremens it works quite satisfactorily, but in maniacal excite- 
ment, melancholia and erotomania it is a very uncertain agent. 
It is extremely useful in nervous dysmenorrhcea and, combined 
with morphine, is commonly relied upon for the relief of after- 
pains. There are, indeed, many conditions met with in women 
to the alleviation of which no one remedv seems so well 



304 PHARMACOLOGY AND THERAPEUTICS. 

adapted as camphor. Monobromated camphor is used as 
a nervous sedative. Its action is not identical with that of 
the bromides, however, as the bromine is present in a differ- 
ent form, and it is stated that no bromine ion is liberated; so 
that the bromine effect would seem to be quite limited. Cam- 
phoric acid is successfully administered for colliquative sweat- 
ing, e. g., that of pulmonary tuberculosis. The daily amount of 
from 1 to 5 gm. (15 to 75 gr.) should be given in the evening 
in divided doses at short intervals, either dry upon the tongue 
or in starch wafers. It has been used with success also in 
hyperidrosis occurring in a variety of cases which were non- 
tuberculous. 

MUSK. 

MOSCHUS.— Musk. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparation. 
Tinctura Moschi. — Tincture of Musk. Dose, 4 c.c; 1 fl. dr. 

Action of Musk. 
Musk is regarded as stimulant and antispasmodic. It is sup- 
posed to act in the same way as camphor, but almost nothing 
is definitely known in regard to this substance. The odoriferous 
matter, which is believed to be the active principle, has scarcely 
been examined. According to some early observations musk 
was found to cause headache, giddiness and confusion, with a 
feeling of weight and uneasiness in the stomach; later, de- 
pression and drowsiness, and eventually sleep. Tremors and 
even convulsive movements were also sometimes noticed, and 
the pulse was said to be accelerated and quickened. A later 
investigator, however, reported (in 1888) that he could find no 
effects from the administration of musk to men or animals. 

Therapeutics of Musk. 
In recent years the use of musk has been almost entirely dis- 
carded. Its effects appear to be very uncertain at best, and 
as most of the musk on the market is adulterated, and moreover 



ACONITE. 305 

its price is extremely high, there would seem to be very little 
reason for retaining the drug in medicine. Its therapeutic use 
has always been almost purely empirical, and it has been sug- 
gested that it was probably thought that a substance with such 
a powerful odor could not but possess a marked physiological 
action, although no such action was ever demonstrated. Musk 
has been mainly used in spasmodic diseases, such as chorea, 
whooping-cough, hiccough, and laryngismus stridulus, and as 
a stimulant in asthenic conditions, especially in pneumonia and 
delirium tremens and in typhus, typhoid and other fevers. At 
present it is said to be most often prescribed for the extreme 
weakness which follows typhoid fever. It is usually adminis- 
tered in pill. 

B. Drugs Acting on the Vagus Centre. 
ACONITE. 

1. ACONITUM.— Aconite. Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Fluidextractum Aconiti. — Fluidextract of Aconite. Dose, 
0.05 C.C.; 1 TTL. 

2. Tinctura Aconiti. — Tincture of Aconite. Dose, 0.6 c.c; 
10 TTL- The strength of this tincture has been reduced from 35 
gm. of aconite in 100 c.c. (U. S. P., 1890) to 10 gm. in 100 c.c. 

2. ACONITINA.— Aconitine. Dose, 0.00015 gm. (0.15 milligm.); 

Unofficial Preparations. 
Extractum Accniti. — Extract of Aconite (U. S. P., 1890). 
Dose, 0.010 gm.; y 5 gr. 

Unguentum Aconitinse. — Aconitine Ointment. 
Colloidum Amyle.— Amyl Colloid. (Anodyne Colloid.) 

Action of Aconite. 
The action of aconite is due chiefly to its constituent, acon- 
itine, which is recognized as the most toxic of all known 
alkaloids. 



306 PHARMACOLOGY AND THERAPEUTICS. 

External. — Locally it is an irritant, but, unlike other local 
irritants, it does not cause redness, blistering or other sign of 
inflammation. Applied to the skin or mucous membrane, it 
soon affects the peripheral ends of the sensory nerves, causing 
itching, tingling and burning. This stimulation is followed by 
numbness, and later by complete paralysis of sensation in the 
part. Inhaled through the nostrils, it gives rise to sneezing 
and symptoms of coryza, with an icy cold sensation. 

Internal. G astro -intestinal Tract. — When taken by the 
mouth it causes a disagreeable prickling and sense of constric- 
tion in the fauces. Other mucous membranes become affected, 
and various reflexes, such as sneezing, coughing, increased flow 
of saliva, nausea and vomiting, may be produced by the irri- 
tation of the sensory terminations. This stimulation is suc- 
ceeded by a depression which gives rise to a sense of numbness 
in the different surfaces. Unless the dose is excessive, purg- 
ing is not caused, and even then it occurs only in occasional 
instances. 

Heart and Circulation. — The action of aconite on the heart is 
somewhat complex, and, if given in sufficient amount, it has the 
effect of successively stimulating and paralyzing all the differ- 
ent parts of the organ's mechanism. Under small doses the 
only symptoms produced are those due to stimulation of the 
vagus centres in the medulla, the primary action of the drug. 
As a result, the rate of the heart is slowed, the diastole is in- 
creased, the systole is diminished, and there is a fall in blood- 
pressure. That these effects are due to stimulation of the 
inhibitory centres is shown by the fact that if the vagus is 
divided the heart-beat returns to the normal. With larger 
doses the primary slowing action is the same, but this is soon 
followed by results due to the direct action of the drug upon 
the heart itself, as well as its influence upon the vaso-motor 
centres. The rhythm becomes markedly accelerated, instead of 
abnormally slow. This acceleration has been attributed to 
paralysis of the vagus terminals, but that it is not due entirely or 
principally to this is shown by the fact that it occurs after 



ACONITE. 



30/ 



section of the vagus. There is evidently a powerful stimulation 
of the cardiac muscle, and the action of the heart becomes not 
only very rapid but also extremely irregular. The blood- 
pressure likewise becomes exceedingly irregular, now falling 
to zero, and now rising again to a considerable extent. The 
contractions of both the auricle and ventricle are imperfect 
and very unequal, the one part often beating at a different rate 
from the other. The ventricular action tends to become more 
rapid than the auricular, and the increasing irritability of the 
heart eventually results in delirium cordis. Finally the vaso- 
motor centres become paralyzed and lose their function. 
There is always in the end a complete fall in pressure from 
paralysis of the heart and blood-vessels. Clinically it appears 
that the peripheral vessels are dilated, and this effect is some- 
times very marked. Aconite has been named the " vegetable 
lancet." 

Xeri'ous System. — There is still considerable uncertainty as 
to the mode and order in which the different parts of the 
nervous system are affected by aconite, and one reason for this 
is that the symptoms due to the action of the drug on the 
central nervous system are to a greater or less extent obscured 
by its effects on the peripheral nerve terminals. On the cere- 
brum it has apparently but little influence. In cases of poison- 
ing by it the intellectual faculties are not affected, and con- 
sciousness usually remains to the end. If the latter is lost or 
impaired this may be due to changes in the circulation and 
respiration, or possibly to collapse resulting from paralysis of 
the medullary centres. Xear the end carbonic acid narcosis 
may supervene. Aconite has decided effects on the medulla, 
and its action on the vagus centre has already been referred 
to. It is also believed that it affects the vaso-constrictor centre 
and that the vomiting so frequently present is due. at' least in 
part, to increased irritability of the medullary centres. There 
is dilatation of the pupil, and this is regarded as due to stimu- 
lation of the central dilator apparatus, while the convulsions 
which are not infrequently observed are also attributed largely 



308 PHARMACOLOGY AND THERAPEUTICS. 

to central stimulation. The spasms have been thought to he 
chiefly respiratory, but the fact that they are not altogether 
absent in frogs, and not always relieved by artificial respiration 
in mammals, indicates, it is held, an effect, in part, central. 
The action of aconite on the spinal cord has not as yet been 
definitely determined, but the reflex function of the cord is 
apparently impaired by it. Some authorities hold that it 
primarily stimulates the motor portion of the cord, and at a very 
late period in its toxic action causes centric motor depression. 
Its action on the motor spinal cord, however, is believed to be 
entirely subservient to its influence on the peripheral nerves. 
The weight of evidence goes to show that it causes paralysis 
of the sensory nerves, commencing at their peripheral termi- 
nations and extending eventually to the centre of sensation in 
the cord, and that the loss of reflex activity noted is due, at 
least in great part, to the peripheral paralysis; furthermore, 
that the motor nerves, upon which it exerts a feeble depressing 
influence, are not affected until after the sensory nerves. 
Under toxic doses of aconite the special senses may be more or 
less interfered with, and the general sensibility is always greatly 
diminished, so that marked anaesthesia of the surface is a 
prominent characteristic. 

Respiration. — In moderate doses aconite usually has the effect 
of quieting the respiratory movements. Under toxic doses the 
respiration is at first quickened, but soon becomes very slow and 
labored. When the full effect of the drug is produced both 
inspiration and expiration are prolonged, and the latter is fol- 
lowed by a long pause. Between the primary quickening and 
the subsequent permanent slowing the respiration is some- 
times very irregular, and from the first there is always marked 
dyspnoea. The respiratory trouble has been shown not to be 
due to action on the phrenic terminations, and it does not re- 
sult from stimulation of the vagus endings in the lungs, be- 
cause section of the vagi does not prevent the slowing. It 
seems certain, therefore, that it is caused by the depressing 
action of the drug upon the respiratory centre in the medulla; 



ACONITE. 3O9 

and it has been found that paralysis of this centre begins early. 
It may sometimes occur that the heart ceases before the re- 
spiratory movements, but paralysis of the respiratory centre, 
rather than cardiac paralysis, constitutes the usual cause of 
death in aconite poisoning. The paralysis of this centre prog- 
resses more quickly than that of any other, and it is possible, 
therefore, for death to take place from asphyxia while the 
rest of the central nervous system still continues irritable, as 
shown by the occurrence of convulsions. 

Temperature. — Attention has been called by certain observers 
to the peculiar effect (one that is unique) which aconite has of 
causing a chilly sensation that occurs before either the tem- 
perature or the circulation through the skin is changed. This, 
it is thought, must result from a stimulation of certain tempera- 
ture nerves. Both in febrile conditions and in the normal state 
aconite has the effect of markedly reducing the temperature. 
It is not positively known in what manner this fall is brought 
about, but it seems probable that it is due in great part to the 
influence of the drug upon the nervous centres regulating heat 
production and to its action on the circulation. A considerable 
amount of radiation, it might be expected, would take place 
from the surface of the body in consequence of the lowering of 
the blood-pressure and dilatation of the peripheral vessels 
caused by it, and the increase of perspiration which is also one 
of its effects no doubt assists in the reduction of the tempera- 
ture. The lessening of the supply of oxygen to the tissues 
occasioned by the interference with the circulation and respira- 
tion is shown by the cyanotic appearance of the mucous mem- 
branes, and this, it is believed, is largely instrumental in causing 
the fall. 

Skin. — Profuse sweating is an almost constant symptom when 
large doses of aconite are taken. Whether it has any direct 
action on the perspiratory glands or not is not definitely known, 
but the dilatation of the cutaneous vessels to which reference 
has been made would seem, by increasing the blood-supply of 
the parts, to facilitate an increased sudoriparous excretion. It 



3IO PHARMACOLOGY AND THERAPEUTICS. 

is probable, therefore, that aconite does have some positive 
diaphoretic action, but, even if this is the case, the cold 
perspiration so commonly observed is undoubtedly largely 
attributable to the collapse induced by the drug. In occasional 
instances an erythematous rash is caused by it. 

Kidneys. — Aconite has some influence on the kidneys, but 
this diuretic action is one of its minor effects. It thus in- 
creases elimination to a certain extent, and not only the watery, 
but the solid constituents, of the urine are said to be aug- 
mented by it. Aconitine is excreted mainly through the kid- 
neys. 

Benzaconine. — Benzaconine is very much less poisonous than 
aconitine, the toxic effect of the latter being found by experi- 
ment to be nearly two hundred and fifty times greater in warm- 
blooded animals. In many of its actions it is also distinctly 
opposed to aconitine. It slows the pulse-rate, and its special 
effect on the heart, when given in sufficient quantity, is to 
retard the systole of the ventricles, so that eventually there 
may be only one beat of the latter to two or even three of the 
auricles. Section of the vagus, it is found, does not materially 
affect this action, which therefore appears to be chiefly on the 
cardiac muscle, and which naturally occasions a marked re- 
duction of blood-pressure. The alkaloid is thus the physiological 
antagonist of digitalin. It depresses the vaso-motor centre, but 
this occurs quite late in its toxic action. It acts powerfully on 
the motor nerves, but affects the sensory nerves only at a late 
stage, if at all. By some of the best authorities it is denied 
that it has any influence on the sensory terminations, and prac- 
tically it is found that it does not produce tingling or numbness 
of the mucous membranes. Unlike aconitine, it gives rise to a 
lethargic or semi-comatose condition. In very large doses it 
has a depressing effect upon respiration, but it causes a very 
slight reduction of temperature. 

Aconine. — This is a very feeble agent, but, given in sufficient 
quantity, it has the effect of strengthening the heart-beat. Its 
action is distinctly opposed to that of aconitine, as it stimulates 



ACONITE. 3 I I 

ventricular contraction and so tends to prevent cardiac ase- 
quence and inco-ordination. It does not affect the vasomotor 
centre, but has a stimulating effect on the roots of the vagi. 
Like curare, it paralyzes the terminations of the motor nerves, 
the suspension of function lasting for a considerable time; but 
the paralysis is not preceded by any excitement or spasmodic 
action. When death is caused by it this is in consequence of 
failure of the respiration, which is probably of peripheral origin 
rather than dependent upon depression of the respiratory centre 
in the medulla. It is thought to be unlikely that the alkaloids 
aconine and benzaconine have any influence on the action of 
aconite preparations, but the question is still an undecided one. 

Therapeutics of Aconite. 
External. — The benumbing effects of aconite when locally 
applied have naturally suggested its external use in a variety 
of painful affections, and it is sometimes of considerable service, 
especially in facial and other neuralgias. Among the other con- 
ditions in which it has been employed are pruritus, prurigo, papu- 
lar eczema, chilblains and herpes zoster. In the last-named affec- 
tion care must be taken not to apply it to ruptured vesicles, and 
any preparation containing it should be used with great caution, 
if at all, upon an abraded cutaneous surface, on account of 
the danger of absorption. It is also used locally for the relief 
of the pain of chronic rheumatism, gout, myalgia, and inflamma- 
tions of the structures of the eye and ear. In the different con- 
ditions mentioned above it may be applied either in the form of 
the tincture or in an ointment or liniment. The official aconitine 
ointment of the B. P. (aconitine dissolved in alcohol, i; oleic 
acid, 8; benzoinated lard, 41) is a very expensive preparation, 
and as a substitute for this the liniment (B. P., a 40 per cent, 
solution of powdered aconite root in alcohol, to which 2 per cent, 
of camphor is added), may be painted on with a camel's hair 
brush. Other useful liniments are the Linimentum Aconiti Com- 
positum (not official), known as A. B. C. liniment because it 
contains equal parts of aconite, belladonna and camphor lini- 



312 PHARMACOLOGY AND THERArEUTICS. 

ments, and the " Baltimore liniment," consisting of tincture of 
aconite and chloroform with soap liniment. Occasionally deep- 
seated pains, such as syphilitic pains in the bones and those due 
to sciatica are relieved by such liniments or by aconitine oint- 
ment, and sometimes veratrine may be advantageously combined 
with aconitine in local applications. 

Internal. — While aconite is contra-indicated in all cases where 
the heart is weak and in adynamic conditions in general, it has 
a considerable range of usefulness, and it would seem probable 
that at the present time it is not employed to as great extent as 
it really deserves. In the early stages of acute inflammatory 
diseases it often acts very happily, and the more promptly it is 
resorted to the greater will be the benefit derived from it. It 
reduces the temperature and the arterial tension, quiets the 
heart, allays pain by its influence on the sensory nervous sys- 
tem, and promotes elimination by its action on the skin and kid- 
neys. By its additional effect of slowing the respiratory move- 
ments it is of special value in some of the acute affections of 
the organs of respiration, the work of which is thus materially 
lessened. Among the conditions in which it can be used with 
advantage, if administered sufficiently early, may be mentioned 
coryza, pharyngitis, tonsillitis, bronchitis, pleurisy, pericarditis, 
gonorrhoea, urethral fever resulting from the passage of in- 
struments, congestion and inflammation of the liver, peritonitis, 
puerperal metritis and peritonitis, inflammation of the cerebral 
and spinal meninges, cerebro-spinal meningitis, and the active 
fever of acute cerebral congestion. It will be understood, how- 
ever, that it should never be given when the disease present is 
of an adynamic type, nor should its use be continued after 
effusion has taken place in the serous inflammations or after 
the febrile movement has abated in the others. The best prep- 
aration for internal use is the tincture, and the exhibition of 
this in minute quantities at frequent intervals during the day, 
followed by a full dose of Dover's powder at night, is con- 
sidered one of the best ways to " break up a cold." In catarrhal 
and fibrinous pneumonia it is more particularly useful before 



ACONITE. 3 I 3 

exudation has occurred, but may sometimes be continued after- 
ward in order to combat the inflammatory processes. In acute 
pleurisy before the stage of effusion and in some other inflamma- 
tions, notably peritonitis, great benefit may be derived by com- 
bining it with some preparation of opium, such as the deodorized 
tincture. In what are known as irritative fevers, especially 
among children, it is an extremely useful remedy. In small and 
repeated doses it usually brings about a free diaphoresis, and 
then the temperature promptly falls. It has been highly com- 
mended in the early stage of scarlatina, as not only reducing 
the temperature and acting favorably on the skin and kidneys, 
but also checking the nasal, faucial and aural inflammations 
which often constitute such serious complications and sequelae 
of the disease. In measles it sometimes serves the purpose of 
arresting the catarrhal pneumonia which is one of the most 
dangerous complications of this affection. At times it is also 
of service in the hot stage of the paroxysms of malarial fever. 
In typhoid and other continued fevers of asthenic character it 
should be carefully avoided, and it is also contra-indicated in 
inflammatory conditions of the gastro-intestinal mucous mem- 
brane. One of the diseases in which it has been employed with 
the best effect is erysipelas of the non-traumatic variety, and 
especially facial erysipelas. When, however, the affection is 
of an adynamic type and the eruption presents a dusky appear- 
ance, belladonna should be resorted to instead of aconite. 
Aconite may be of service in acute rheumatism when there is 
much heat and a dry skin, instead of the more common sweating, 
and if it is desirable to bring about a very free action of the 
skin it is recommended to combine it with pilocarpine and anti- 
pyrine. It is also sometimes beneficial in muscular rheumatism 
when there is considerable temperature. 

In conditions in which there is high arterial tension, chiefly 
of cardiac origin, aconite is a remedy of the greatest possible 
value. It is especially indicated in cases without valvular dis- 
ease in which there is hypertrophy and over-action of the heart, 
and likewise when with valvular disease there is excessive com- 



314 PHARMACOLOGY AND THERAPEUTICS. 

pensation. It is particularly useful in cardiac neuroses. In 
simple nervous palpitation of the heart it is of great service, 
and it has sometimes also been found to relieve the pain 
of aneurism. While it has the power of allaying over-excite- 
ment of the sensitive nerves, it has little effect in relieving such 
affections as migraine, where the pain is of central origin. It 
has a certain amount of value in the treatment of neuralgias, 
but is generally less efficient when given internally than when 
locally applied, and is inferior in such affections to some other 
remedies at our command. It should be stated, however, that 
very satisfactory results have been reported from the use of 
Duquesnel's aconitine in trigeminal neuralgia. While not 
affording relief in all cases, in a considerable proportion of in- 
stances it was found to be remarkably successful. It is of 
more or less service in acute maniacal delirium and other mental 
affections, where vascular excitement and high arterial tension 
are present, but gelsemium has proved more efficient in this 
class of cases. It sometimes has an excellent effect in con- 
trolling the vomiting of pregnancy, and this has generally been 
attributed to its influence upon the peripheral sensory system, 
but may perhaps be due to its action in benumbing the sensory 
reflex centres. In gonorrhoea it is thought to prevent chordee 
by its effect on the nervous centres. It may prove useful in 
spasmodic croup, and in certain cases of asthma, if adminis- 
tered early, it affords relief. It sometimes acts well in acute 
suppression of the menses from cold, and it has been found a 
valuable remedy in congestive dysmenorrhea in the full-blooded. 
In epistaxis occurring in plethoric subjects it is also of service. 
Finally, aconite is said to be an antidote to the sting of the 
scorpion. 

TOXICOLOGY. 

Symptoms. — If the dose is sufficiently large, death (probably due to 
cardiac paralysis) may occur almost instantaneously. When the quan- 
tity taken is smaller, the effects of the drug are soon felt. The charac- 
teristic burning and prickling in the mouth, followed by a sense of 
numbness, extends to the stomach, and eventually to the skin. There 



VERATRUM. 315 

is a profuse flow of saliva and in some cases vomiting, while the cuta- 
neous surface becomes covered with a cold sweat. The pulse, at first 
slow as well as feeble, may afterwards become very rapid and scarcely 
perceptible. The respiration is labored, shallow, and accompanied by 
marked dyspnoea. The patient's face is pale and anxious and there is 
great restlessness and general distress, with a sense of extreme fatigue 
and a loss of muscular power. With tingling and numbness in the 
extremities and more or less over the surface, there is a diminished 
sensibility to pain. The pupils remain dilated. Convulsions frequently 
precede death, which is generally due to paralysis of the respiratory 
centre, perhaps aided by anaemia of the medulla, but may be caused by 
paralysis of the heart. Under lethal doses the fatal result usually oc- 
curs in from two to six hours. 

The post-mortem appearances met with are not constant, but are 
generally such as are characteristic of death from asphyxia. 

Treatment. — Emetics may be tried, but will probably fail on account 
of the benumbed condition of the gastric mucous membrane. If the 
symptoms are very severe, it is better not to attempt to excite vomit- 
ing, on account of the risk of its causing fatal syncope. The stomach 
must therefore be evacuated by means of a stomach-pump or tube. The 
patient should be kept flat on his back, with the feet somewhat higher 
than the head, and artificial respiration should be resorted to as soon 
as difficulty of breathing occurs. His body should be wrapped in 
blankets and hot water bottles applied to the soles of the feet, or other 
means employed to maintain the temperature. Tannic acid is to some 
extent an antidote to aconite and may be tried ; but is not to be de- 
pended upon. The main reliance must be upon stimulation. By the 
mouth ammonia and alcoholic stimulants may be administered, and for 
hypodermatic use it is recommended that ether, alcohol, and digitalis 
be given in the order named ; the ether acting most promptly and sup- 
porting the heart until the alcohol can be absorbed, and the alcohol 
continuing the support until the digitalis, which is the physiological 
antagonist of aconite but acts slowly, has had time to produce its effects. 
In addition, strychnine should also be given subcutaneously in full 
doses, as a stimulant to the heart and respiration. If the case seems 
to require it, ammonia may be injected into the veins, and the inhala- 
tion of amyl nitrite may be cautiously employed. Other agents which 
partially antagonize the effects upon the heart and respiration are caf- 
feine and atropine. 

VERATRUM. 

1. VERATRUM (Veratrum Viride, U. S. P., 1890).— Veratrum. 
Dose, 0.125 gm. (125 milligm.) ; 2 gr. 



3 l6 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Fluidextractum Veratri. — Fluidextract of Veratrum. 
Dose, 0.1 c.c; V/ 2 Tib 

2. Tinctura Veratri. — Tincture of Veratrum. Dose, 1 c.c; 
15 til. 

2. VERATRINA.— Veratrine. Dose, 0.002 gm. (2 milligm.) ; ^ 
gr. 

1. Oleatum Veratrinae. — Oleate of Veratrine. 

2. TJnguentum Veratrinae. — Veratrine Ointment. 

Unofficial Preparation. 
Colloidum Amyle. — Amyl Colloid. (Anodyne Colloid.) 

Action of Veratrum. 

The alkaloids of veratrum have been the subject of consider- 
able discussion, but according to the latest authorities, while 
jervine is known to have some action on the system, the activity 
of the drug is really due to veratrine. The latter has a chemical 
composition similar to aconitine, and has practically the same 
action on the central nervous system and the sensory termina- 
tions, but shows, in addition, a peculiar action in prolonging 
the relaxation of striped and cardiac muscle, which is entirely 
absent in aconitine poisoning. The action of veratrum and 
veratrine may, therefore, be considered together. It is neces- 
sary to state, however, that veratrine as found in the shops 
is a mixture of alkaloids generally derived from plants other 
than veratrum viride and veratrum album. The official vera- 
trine is a mixture of alkaloids obtained from the seed of Asa- 
grcea officinalis. 

External. — Applied to the skin the alkaloid veratrine, and 
to a less degree the drug itself, produces a feeling of warmth 
and prickling, followed by a sensation of coldness and by numb- 
ness and anaesthesia. Applied to the mucous membrane of the 
nose and throat, it causes violent sneezing and coughing, and 
a minute portion placed upon the tongue gives rise to burning 
pain and free salivation. These phenomena, as in the case of 



VERATRUM. 3 I 7 

aconite, are due to stimulation of the peripheral endings of the 
sensory nerves. 

Internal. — Gastro-intcstinal Tract. — When full doses are 
taken there are produced burning in the mouth, which spreads 
to the stomach, well-marked salivation, nausea and vomiting, 
and generally purgation accompanied by severe colic. The 
retching and vomiting, which are violent and persistent, have 
been attributed by some to central action and by others to irri- 
tation of the sensory nerve endings, and it seems probable that 
both of these are concerned in their causation. It has been 
supposed that the drug increases the biliary secretion, but the 
amount of bile often noted in the vomit may be simply due to 
the severity of the emesis, which causes the evacuation of the 
contents not only of the stomach but of the gall bladder also. 

Muscles. — There is marked prolongation in the relaxation 
of muscles after contraction, which takes place normally, but 
is more complete than under ordinary circumstances. If a 
tracing be taken of the contraction of a muscle it will be seen 
that the height of the contraction is slightly increased, and that 
instead of the almost instantaneous return to the base-line seen 
in the normal tracing, the curve shows generally a slight undula- 
tion and then a very slow fall, the period of relaxation being 
from twenty to thirty times as long as in the unpoisoned muscle. 
This prolonged relaxation would at first sight appear like 
tetanus, but is entirely free from any element of spasm or rigidity. 
It has been found that it is accompanied by an increased for- 
mation of heat and use of material, and that it is lessened by 
fatigue, cold and other muscle-depressing agents, while in- 
creased by moderate heat. It must therefore be looked upon 
as an expression of greater functional activity, a prolonged con- 
tracture rather than a loss of elasticity. The irritability and 
absolute strength are also increased, so that the muscle re- 
acts to weaker stimuli and contracts against a greater weight 
than usual. That the phenomena noted are not due ■ to any 
nervous influence is shown by the fact that excised muscles 
show exactly the same reaction. It has been found that in the 



3 l8 PHARMACOLOGY AND THERAPEUTICS. 

frog the muscles are finally paralyzed, but that this does not 
occur in mammals because in them the respiratory centre fails 
long before the quantity of veratrine necessary to produce this 
effect has been absorbed. 

Heart and Circulation. — In the frog's heart the ventricular 
muscle is affected by veratrine in very much the same way as 
ordinary striated muscle. The auricular muscle, consisting for 
the most part of unstriated fibres, is much less powerfully in- 
fluenced by it, and in consequence the auricle is found to make 
two, or even three, beats to one of the ventricle. In the mamma- 
lian heart investigation shows that there is no such prolongation 
of the systole as is seen in the frog, but it has been proved that 
a slight stimulating action is exercised by the drug. The prin- 
cipal cardiac effects observed, however, are due to the influence 
exerted upon the medullary centres. As in the case of aconite, 
there is a primary stimulation of the vagus centre, resulting 
in a slowing of the heart's rate and a reduction of arterial pres- 
sure. At the same time constriction of the peripheral vessels 
is produced through stimulation of the vaso-motor centre. After 
larger quantities the pulse is accelerated, the vaso-motor centre 
being depressed and the terminations of the, vagus paralyzed. 
If, in the human subject, while it is depressed the posture is 
changed from the recumbent to the upright, the pulse at once 
becomes extremely rapid and thready. 

Respiration. — The effects on respiration, due to depression of 
the respiratory centre in the medulla, are much the same as 
those of aconite. The breathing is slow and labored and at- 
tended with dyspnoea, and after lethal doses death usually re- 
sults from paralysis of respiration. 

Nervous System. — That the drug has decided actions on the 
medullary centres has already been seen. It also has a stimu- 
lating effect on the spinal cord, but the influence exerted by it 
on the highest cerebral centres is probably but slight, though 
the convulsions produced by it are believed, as in the case of 
aconite, to be due to central stimulation. It acts to some extent 
on the motor nerves, and its effects on the sensory nerve end- 



VERATRUM. 3I9 

ings have been previously mentioned. After large doses the 
stimulation of the central and peripheral nervous system is suc- 
ceeded by paralysis. 

Skin. — It produces free sweating, but this is probably the re- 
sult of arterial depression, rather than of any specific diaphoretic 
action. 

Temperature. — There is generally under its influence a con- 
siderable reduction in temperature, which is thought to be due 
to the increased heat-dissipation resulting from vaso-motor 
paralysis and the slowing of the circulation. In cases, how- 
ever, where the convulsions are marked, increased heat-produc- 
tion is caused by the violent movements, and the temperature 
is even higher than normal. 

Therapeutics of Veratrum. 
Veratrum is a prompt and sure circulatory depressant, and 
its administration is safe because, the physiological action of 
the drug giving warning of danger, its use can be stopped in 
time to prevent accidents. In cardiac cases where there is ex- 
cessive hypertrophy, and drugs of the digitalis class are contra- 
indicated, it is less advantageous than aconite, which is more 
persistent in its effects and not so apt to cause gastric disturb- 
ance, but in a number of other affections where the aim is to re- 
duce arterial action it is held in deservedly high repute. Thus, 
in the early stages of sthenic croupous pneumonia it has long 
been considered one of the most reliable of remedies, quieting 
the increased action of the heart, lowering the temperature, and 
lessening the congestion of the lung. It may also be used with 
advantage, if given sufficiently early, when only hyperemia is 
present, in pleurisy, hepatitis, cerebritis, maniacal delirium, 
mania a potu, with strong, bounding pulse, and other sthenic 
conditions. If its employment is maintained after the primary 
stage of congestion, however, it can only do harm. In acute 
gastritis and peritonitis it is generally contra-indicated on ac- 
count of its irritating effect upon the stomach, though in peri- 
tonitis it may sometimes be of service if carefully watched. In 



320 PHARMACOLOGY AND THERAPEUTICS. 

aneurism where there is marked disturbance of the circulation 
and high pressure its cautious use is recommended, to decrease 
the pressure and prevent rupture of the diseased vessel; and it 
may prove a valuable adjunct to rest and other means of treat- 
ment. The production of vomiting should be avoided, if possi- 
ble, and the patient should therefore be kept in a strictly recum- 
bent position, while a small amount of opium may be given with 
the remedy. With the various surgical expedients, such as 
forced flexion, compression and ligation, for the cure of aneurism 
it has also sometimes been employed, with excellent results, for 
lessening the force of the blood-current and the rapidity of the 
pulse-rate. The action of veratrum is regarded as similar to 
a depletion, but without the permanent loss of blood, and on 
account of its influence in causing depression it has been desig- 
nated as " the younger brother of tartar emetic." 

The very marked efficiency of the drug (especially in the 
form of Norwood's tincture) in puerperal eclampsia has been 
attested by a large accumulation of the most trustworthy evi- 
dence, and by many physicians it is considered by far the best 
remedy at command in this condition. Its good effects have 
generally been attributed mainly to the depressing influence of 
the drug upon the motor tracts of the spinal cord; but, while 
this influence no doubt contributes in some measure to the 
beneficial results, its action in this respect is neither so energetic 
or sure as a number of other drugs, and its effect must there- 
fore be regarded as due to a very considerable extent to its 
action on the circulatory system. In puerperal convulsions the 
spasmodic condition is generally associated with abnormally 
high intravascular tension, and veratrum would consequently 
seem to be especially indicated. In this affection it has been 
pointed out that it possesses the double recommendation — (i) 
that it affords a certain and rapid means of lowering the blood- 
pressure; (2) that although it is not cumulative to any marked 
degree, its action is long maintained, and may be perpetuated by 
a repetition of small doses. Sometimes, however, quite large 
doses are well borne, and successful cases have been reported 



VERATRUM. 32 I 

where as much as 1.20 c.c. (20 1U) of Norwood's tincture has 
been given every hour for five consecutive days and nights. In 
the early stage of peritonitis, phlebitis and other inflammatory 
affections of the puerperal state it may also prove of service, if 
there is no cardiac weakness or general adynamia. Among the 
various other diseases in which its early use is said to have been 
attended with satisfactory results are acute rheumatism and 
tonsillitis, in the latter instance combined with morphine. It 
has also been given in the case of certain wounds which tend 
to dangerous results, like those of the head, pericardium, heart 
and peritoneum, with the idea of securing, by means of the 
diminished arterial movement caused by it, as little motion of 
the affected part as possible. It should never be employed to 
produce vomiting, as it is too harsh and depressing in its effects. 
Notwithstanding the criticisms of those who regard it as a type 
of those cardiac sedatives which tend, it is claimed, to retain in 
the blood all that is injurious in it and at the same time to re- 
duce the patient to a state of utter wretchedness, veratrum 
undoubtedly has a legitimate, though limited, field in thera- 
peutics, and, within its proper range, is still esteemed by a large 
number of practitioners as a remedy of great value. 

Therapeutics of Veratrine. 
External. — Veratrine (as an oleate or ointment) is chiefly 
employed, either alone or in combination with other remedies, 
in the external treatment of neuralgia, myalgia, herpes zoster, 
acute gout, and other painful affections. Used locally it has 
also been found of service in alopecia circumscripta, chloasma, 
and chronic swelling and stiffness of the joints. For ordinary 
use the official ointment is too strong, and should be reduced 
one-half or more, or the oleate may be substituted for it. In 
a weakened form it is sometimes employed in infantile paralysis, 
for the alleged purpose of improving the nutrition of the affected 
muscles. In the external application of veratrine preparations 
care should always be taken to avoid abrasions of the cuticle, 
on account of the danger of absorption. They should likewise 



322 PHARMACOLOGY AND THERAPEUTICS. 

be used with caution near the eye, as violent inflammation of 
the conjunctiva will be set up if any of the veratrine comes in 
contact with it. {See also Amyl Colloid, below.) 

Internal. — Veratrine is very rarely given internally. It has, 
indeed, been suggested by one authority that as its activity is 
due to this alkaloid, veratrum might well be dropped from 
the Pharmacopoeia, but the fact remains that veratrum is 
still held in high repute as a circulatory depressant, while 
veratrine is practically discarded. Probably the chief reason 
for this is the dangerousness with which the alkaloid is re- 
garded, and it is authentically recorded that alarming symptoms 
have been produced by a dose of only 0.004 g m - (tV § r 0- 

Action of Amyl Colloid. 
The object of this preparation is to obtain in an elegant and 
convenient way the local anaesthetic action of both aconitine and 
veratrine, aided by the evaporation of amyl hydride. It is 
found extremely difficult, however, to make a clear solution. 

Therapeutics of Amyl Colloid. 
In neuralgia, sciatica, and other similar affections it is painted 
on the skin over the painful areas, and its anaesthetic effect may 
be still further promoted by the application of warm moist 
spongiopiline over the film formed by the collodion. 

TOXICOLOGY. 

Notwithstanding the severity of the symptoms caused by it, and 
although it has often been given with great freedom, fatal results 
have very seldom been noted from the use of veratrum. This is 
probably explained, at least to a considerable extent, by its prompt 
ejection from the stomach in consequence of the emesis produced by 
large doses taken by the mouth. As most of the symptoms of poison- 
ing by the drug have already been given, a further detailed description 
is unnecessary. There is often very severe abdominal pain, and head- 
ache and giddiness are common. There may or may not be muscular 
twitchings. After veratrine especially the convulsive movements are 
sometimes very marked. There is extreme debility, the features are 



CACTUS. 323 

pinched, and there is usually great pallor, with a cold and clammy skin. 
The medullary and spinal centres become paralyzed, and death results 
from respiratory collapse, adjuvated by failure of the circulation. The 
post-mortem changes are not characteristic. 

Treatment. — The treatment is practically the same as in aconite 
poisoning, though the contents of the stomach are usually efficiently 
evacuated by the action of the drug itself. Atropine has proved of 
some value in the poisoning of animals by veratrine, and its use is sug- 
gested on account of its action on the respiratory centre and on the 
vagus terminations in the heart. As the poison is rapidly excreted 
through the urine, it has also been recommended to administer hot tea 
as a diuretic. 

C. Drugs Acting on the Accelerating Centre. 
CACTUS. 
Unofficial Preparations. 
Cereus G-randifLorus. — Cereus Grandiflorus. (Night-blooming 
Cereus.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr. 

Fluidextractum Cacti. — Fluidextract of Cactus. Dose, 0.60 
to 2 c.c; 10 to 30 TTL - 

Action of Cactus. 
Cactus is non-irritating, but the crude drug is said to be 
used as a counter-irritant, and to produce pustulation. The 
action of cactus is upon the intra-cardiac ganglia and acceler- 
ator nerves, through the cardiac plexus of the sympathetic, and 
there is not any interference with the inhibitory nerves, nor, 
indeed, does its administration produce any very marked vaso- 
motor changes. It shortens the ventricular diastole, thus quick- 
ening the pulse, and increases the blood-pressure. Cactus is also 
said to have a stimulating effect upon the spinal nerve-centres 
and to increase the general nerve-tone. 

Therapeutics of Cactus. 
It is useful in cardiac weakness, that is, relative incompetency ; 
in convalescence from typhoid fever; in simple eccentric cardiac 
dilatation; in functional cardiac diseases, from tea, coffee, tobacco 



324 PHARMACOLOGY AND THERAPEUTICS. 

and alcohol, dyspepsia, exophthalmic goitre, neurasthenia of 
the climacteric, sexual exhaustion ; in the " slow heart," from 
over-stimulation of the pneumogastric or degeneration of the 
muscular wall of the ventricles. It is of very great use in aortic 
regurgitation, but is absolutely contra-indicated in mitral 
stenosis, thus being of value in those cases where the use of 
digitalis is inadmissible. It has also been found of service in 
some cases of angina pectoris, more particularly pseudo-angina. 
Cactus has a sphere of action entirely its own; not, however, 
replacing other remedies used for cardiac disease, though it 
is useful in many cases where these drugs are not only dan- 
gerous, but absolutely contra-indicated. Failures to obtain re- 
sults depend upon the fact that many adulterated specimens are 
found in the shops, or upon the use of inert, dried material. 
If made from the green plant, as it should always be, the fluid- 
extract is of a peculiar green color. Cactus, in the form of 
this preparation, is the only remedy known which will quicken 
a slow heart. It deserves a better recognition in cases of this 
kind, few indeed, yet nevertheless presenting themselves, for in 
such it oftentimes yields brilliant results. 

Division IV. — Drugs Acting on the Vessels. 
The effects are usually determined (1) by direct observation 
of alterations caused by the drug in the size of the vessels of 
some thin structure, such as the ear of the rabbit, the wing 
of the bat, or the web, lung, mesentery, tongue or mylo-hyoid 
muscle of the frog; (2) by observing the rate at which the blood 
flows from the cut vessel of an animal, both under and without 
the influence of the drug. In order to exclude influences acting 
on the cardiac mechanism, the maintenance of an artificial cir- 
culation is quite commonly resorted to, and destruction of the 
spinal cord or section of the nerves supplying the part is re- 
quired to determine whether the changes observed are due to 
local or central effects. When alterations in the vessels result 
from the local application of a drug it is often uncertain, if 
the nerves supplying the part are not divided, whether the effect 



DRUGS ACTING LOCALLY ON VESSELS. 325 

is reflex or direct. It is probable that some of the drugs act 
by the vaso-constrictor and some by the vaso-dilator nerves, 
both of which kinds of nerves connect the vessels with the 
central nervous system; but they can be classified only gen- 
erally into those drugs which dilate or constrict the vessels by 
local action and those which do so through their action on 
the central nervous system. In the case of those acting locally 
it is impossible to determine whether they affect the muscular 
coat of the vessel or the nerve terminations. It can readily 
be seen that drugs which act on the heart or on a large area 
will have a considerable effect upon the general blood-pressure. 
Drugs are applied to the interior of vessels by injecting them 
into the circulation. 

A. Drugs acting locally on Vessels. 
1. Vaso-dilators. 

Drugs which, when locally applied to vessels, dilate them: 



(16) All volatile oils, as oils of 
turpentine, and many sub- 
stances containing them, 
as mustard, horse-radish, 
etc. 



(1) Liquor Ammonise. 

(2) Silver nitrate -\ 

(3) Zinc chloride r (strong) 

(4) Copper sulphate 

(5) Mercuric nitrate. 

(6) Arsenic trioxide. (17) Senega. 

(7) Antimony and potassium (18) Chrysarobin. 

tartrate. (19) Ipecacuanha. 

(8) Iodine. (20) Capsicum. 

(9) Chlorine. (21) Croton oil. 

(10) Mineral acids (strong). (22) Camphor. 

(11) Alcohol. ") If prevented (23) Cantharides. 

(12) Ether. I from evapo- (24) Phosphorus. 

(13) Chloroform. J rating. (25) Warmth, if transiently ap- 

(14) Phenol. plied. (When long applied 

(15) Creosote. it contracts blood-vessels.) 

Irritants. — All of the above, as they dilate the vessels, are often 
spoken of as vascular irritants. 

Rubefacients are drugs which, in consequence of the vascular 
dilatation caused by them, redden the skin when they are applied 



326 PHARMACOLOGY AND THERAPEUTICS. 

to it. Desquamation frequently follows if the action has con- 
tinued for some time. All the above are rubefacients. 

Vesicants. — With many of these drugs the irritant effect is 
sufficient to produce inflammation, and when they cause the 
exudation of serum between the epidermis and the true skin 
and the formation of vesicles or blisters they are known as 
vesicants; e. g., cantharides. 

Pustulants are drugs which produce small discrete suppura- 
tions, the distinct and separate points of inflammation being 
situated at the orifices of the skin glands. They do not affect 
the intervening tissue, probably for the reason that they cannot 
pass through the horny epidermis; e. g., croton oil. 

Escharotics. — With the most powerful of these drugs the irri- 
tation is sufficient to destroy the vitality of the tissues with 
which they came in contact, forming a slough, and to cause 
vascular dilatation in the surrounding parts. They are known 
as eschartics or caustics ; e. g., zinc chloride. 

Counter-irritants. — When any of these drugs are employed 
to produce a reflex influence on a part more or less remote from 
the point of application, they are termed counter-irritants. The 
exact nature of the effects of counter-irritation on internal 
organs has not been determined, but it is considered most prob- 
able that an alteration in the calibre of the vessels and in the 
sensory nerves or their terminations is induced, and that such 
changes may cause or be accompanied by a distinct alteration 
in the activity of the organs. 

The following, when inhaled, dilate peripheral vessels by acting lo- 
cally on them: 



(1) Amyl nitrite. 

(2) Nitroglycerin. 

(3) Sodium nitrite. 



(4) Ethyl nitrite. 

(5) Spiritus aetheris nitrosi. 

(6) Erythrol tetranitrate. 



Drugs which, taken by the mouth, dilate arterioles by acting locally 
on them: 



(1) Caffeine. 

(2) Amyl nitrite. 

(3) Nitroglycerin. 

(4) Sodium nitrite. 



(5) Ethyl nitrite. 

(6) Spiritus aetheris nitrosi. 

(7) Erythrol tetranitrate. 

(8) Nicotine. 



DRUGS ACTING LOCALLY ON VESSELS. 



327 



2. Vaso-constrictors. 

Drugs which, taken by the mouth, contract arterioles by acting locally 
on them: 

(1) Suprarenal extract. (4) Caffeine (early in its ac- 

(2) Barium salts. tion). 

(3) Ergot. (5) Digitalis. 

(6) Physostigmine. 



The following have been shown by experiments to cause contraction 
of small arteries through which they circulate : copper, zinc, tin and 
platinum salts, powerful contraction ; lithium, calcium, strontium, mag- 
nesium, cadmium, nickel, cobalt and iron salts, slight contraction. 

Drugs which, when locally applied to vessels, contract them: 

These may act in two ways: (1) by contracting the muscular 
coat of the vessels; (2) by coagulating the albuminous fluids 
around them, the coagulum by its contraction constricting the 
vessels. 



Those which act on the muscular coat of the vessels 



(1) Cold, temporarily applied. 
(If cold is long continued 
it dilates blood-vessels.) 

(2) Cocaine. 

(3) Lead salts. 

(4) Dilute solutions of silver 

salts. 



(5) Diluted sulphuric acid. 

(6) Alum. 

(7) Hamamelis. 

(8) Ergot. 

(9) Hydrastis. 

(10) Acetanilide. 

(11) Antipyrine. 



Those which coagulate the albuminous -fluids around the vessels: 



(1) Tannic acid and all sub- 
stances containing it : e. g., 
nutgall, krameria, kino, I 
haematoxylon, hamamelis, 
cinnamon, eucalyptus gum, 
and gambir. 

(2) Lead salts. 



(3) Silver salts. 

(4) Zinc salts. 

(5) Copper salts. 

(6) Alum. 

(7) Ferric salts. 

(8) Bismuth salts to a slight 
extent. 



Astringents are drugs which diminish the size of the vessels, 
and thus decrease the amount of exudation from them. They 
produce contraction of muscular fibre by direct irritation and 



328 PHARMACOLOGY AND THERAPEUTICS. 

condensation of other tissues by precipitating albumin and 
gelatin. 

Styptics, or Haemostatics, are drugs which stop bleeding. 
Among them are included all astringents, the most important of 
them being cold, lead and copper salts, hamamelis, ergot, hy- 
drastis, tannic acid, and especially the salts of iron, which 
coagulate escaping blood, while the clot thus formed tends to 
prevent further haemorrhage. Matico leaves, applied to a bleed- 
ing surface, act as a mechanical haemostatic, the numerous hairs 
on their underside favoring coagulation; and cobwebs have a 
similar effect. 

3. Emollients and Demulcents. 

Emollients are substances which soften and relax the parts 
to which they are applied. They serve to relieve tension, dimin- 
ish pressure on the nerves, and also protect inflamed surfaces 
from the air and from friction. 

Common emollients are substances soaked in warm water, as hot 
fomentations and poultices, fats of various sorts, as lard and lanolin 
(hydrous wool-fat) and non-irritating oils, as olive oil, spermaceti, 
petrolatum, vaseline, etc. 

Demulcents are substances which protect and soothe the 
tissues to which they are applied, and are often of a mucilagi- 
nous nature. This name is ordinarily employed for substances 
used for mucous membranes, and that of emollient for those 
used for the skin. Among demulcents may be mentioned gelatin, 
isinglass, glycerin, gum, honey, flaxseed, starch, and white of 

egg- 

Therapeutics. — Drugs which locally dilate vessels are fre- 
quently used as stimulating applications for indolent ulcers and 
sores, as well as to promote the absorption of inflammatory 
products ; also as counter-irritants in various diseased conditions 
in internal organs. Drugs, such as the nitrites, which by their 
central action cause dilatation of all the vessels of the body, 
are employed in cardiac diseases, where the relief which they 
afford is no doubt largely due to their thus diminishing the work 



DRUGS ACTING ON VASO-MOTOR CENTERS. 



329 



of the heart. Others having this general vaso-dilator action 
are used more particularly to cause diaphoresis. 

Astringents are used chiefly as styptics, but also to diminish 
secretion from mucous membranes and check excessive dis- 
charges generally, as well as to obviate relaxed vascular condi- 
tions. 

B. Drugs which act on the Vaso-motor Centres. 

Drugs which, by their action on the vaso-motor centres, dilate the 
vessels : 

(1) Belladonna. 



(2) Stramonium. 

(3) Hyoscyamus. 

(4) Alcohol. 

(5) Ether. 

(6) Chloroform. 

(7) Hydrated chloral. 

(8) Antimony and Potassium 

Tartrate. 



(9) Aconite. 

(10) Ipecacuanha. 

(11) Lobelia. 

(12) Tobacco. 

(13) Veratrine. 

(14) Hydrocyanic acid. 

(15) Opium. 



Some of the substances, which in small doses contract the vessels by 
central action, in large doses dilate them ; viz., digitalis and squill. 

Drugs which, by their action on vaso-motor centres, cause contrac- 
tion of vessels: 



(1) Ergot. 

(2) Digitalis. 

(3) Strophanthus. 

(4) Sparteine. 

(5) Squill. 

(6) Physostigmine. 



(7) Cocaine. 

(8) Hydrastis. 

(9) Hamamelis. 

(10) Strychnine. 

(11) Lead salts 

(12) Ammonia 



(slightly). 



Also, for a very short early period of their action, some substances 
whose main action is to dilate the vessels by their central action ; viz., 
belladonna, stramonium, hyoscyamus, alcohol, ether, chloroform, hydro- 
cyanic acid, and veratrine. 



A. Drugs Acting Locally on Vessels. 

I. Vaso-dilators. 
THE ACIDS. 
1. ACIDUM SULPHURICUM.— Sulphuric Acid. (Oil of Vitriol.) 



330 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Acidum Sulphuricum Dilutum. — Diluted Sulphuric Acid. 
Dose, 2 c.c; 30 ni. 

2. Acidum Sulphuricum Aromaticum. — Aromatic Sulphuric 
Acid. Dose, 1 c.c; 15 m.. 

2. ACIDUM NITRICUM.— Nitric Acid. 

Preparations. 

1. Acidum Nitricum Dilutum. — Diluted Nitric Acid. Dose, 
2 c.c; 30 Hi. 

2. Acidum Nitrohydrochloricum. — Nitrohydrochloric Acid. 
(Nitromuriatic Acid.) Dose, 0.2 C.C.; 3 T1J,. 

3. Acidum Nitrohydrochloricum Dilutum. — Diluted Nitro- 
hydrochloric Acid. Dose, 1 c.c; 15 TTt. 

3. ACIDUM HYDROCHLOEICUM.— Hydrochloric Acid. (Muri- 
atic Acid.) 

Preparations. 

1. Acidum Hydrochloricum Dilutum. — Diluted Hydrochloric 
Acid. Dose, 1 c.c; 15 TT\.. 

2. Acidum Nitrohydrochloricum. — Nitrohydrochloric Acid. 
Dose, 0.2 c.c; 3 n\. 

3. Acidum Nitrohydrochloricum Dilutum. — Diluted Nitro- 
hydrochloric Acid. Dose, 1 c.c; 15 TTL- 

4. ACIDUM PHOSPHORICUM.— Phosphoric Acid. 

Preparations. 

1. Acidum Phosphoricum Dilutum. — Diluted Phosphoric 
Acid. Dose, 2 c.c; 30 TH,. 

2. Elixir Ferri, Quininae et Strychninae Phosphatum. — 
Elixir of Iron, Quinine et Strychnine Phosphates. Dose, 4 C.C. J 
1 fl. dr. 

3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. 
— Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 C.c; 15 TTL. 

4. Syrupus Ferri, Quininae et Strychninae Phosphatum.— 

Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 



THE ACIDS. 331 

5. ACIDUM ACETICUM.— Acetic Acid. 

Preparation. 
Acidum Aceticum Dilutum. — Diluted Acetic Acid. Dose, 
2 c.c; 30 TTL. 

6. ACIDUM ACETICUM GLACIALE.— Glacial Acetic Acid. 

7. ACIDUM TRICHLOEACETICUM.— Trichloracetic Acid. 

8. ACIDUM CITRICUM.— Citric Acid. Dose, 0.500 gin. (500 mil- 
ligm.); 7y 2 gr. 

Preparations. 

1. Syrupus Acidi Citrici. — Syrup of Citric Acid. 

2. Liquor Sodii Phosphatis Compositus. — Compound Solu- 
tion of Sodium Phosphate. Dose, 8 c.c; 2 fl. dr. 

9. ACIDUM TARTARICUM.— Tartaric Acid. Dose, 0.500 gin. 
(500 milligm.) ; 7% gr. 

10. ACIDUM LACTICUM.— Lactic Acid. Dose, 2 c.c; 30 ill. 

Action of Sulphuric, Nitric, Hydrochloric, Phosphoric, 
Acetic, Citric, Tartaric and Lactic Acids. 
External. — All these acids are powerful local irritants. The 
least so is citric. While its concentrated solution does not affect 
the sound skin, it is irritant to mucous membranes and abraded 
surfaces. Next to this comes tartaric, the saturated solution 
of which acts upon the unabraded skin, and when applied to a 
raw surface produces more considerable irritation, with pain 
and heat. The remaining acids are very energetic caustics, and 
even when in very dilute solution cause an irritation which may 
amount to vesication. The nature of the escharotic action 
varies to some extent with the constituents of the tissues with 
which they come in contact, but, on the whole, is found to con- 
sist in withdrawal of water, the formation of acid albumins, 
softening of the connective tissue and epithelium, and, in special 
situations, solution of calcareous material. The most typical 
acids in regard to the local action are sulphuric and hydro- 
chloric. Nitric causes the same effects, but differs in its 



332 PHARMACOLOGY AND THERAPEUTICS. 

chemical action, by which xanthoproteic acid is produced from 
the proteids. Owing to the fact that it does not redissolve the 
albumin it precipitates, its area of action is somewhat limited; 
but nitrohydrochloric is very energetic. Nitric acid, because of 
its special chemical action, stains the skin a deep yellow and 
causes a yellow eschar, while sulphuric, in consequence of its 
leaving the carbon untouched, blackens the surface and causes 
a brown or black eschar. The latter causes necrosis of the skin 
and subcutaneous tissues, which is accompanied by intense pain 
and, if the surface involved is large, by symptoms of shock and 
collapse such as are met with in severe burns. Ricord's paste is 
composed of sulphuric acid and willow charcoal; Michel's, of 
sulphuric acid and asbestos. Hydrochloric acid, though less 
liable to cause wholesale destruction of the skin than sulphuric, 
penetrates the epidermis and causes vesication. Phosphoric is 
considerably less irritant, but causes redness and even blister- 
ing when applied in concentrated solution. Glacial acetic acid 
is especially applicable when a limited action is desired. The 
corrosive action of the acids is much more intense upon mucous 
membranes than upon the skin, and even small quantities of 
strong sulphuric acid striking the eye are sufficient to destroy 
the sight. 

As all the more powerful acids unite with and coagulate 
albumin, solutions of these which are not sufficiently strong to 
form a slough (which by its separation is likely to cause bleed- 
ing), act as astringents and haemostatics, both by coagulating 
the blood, and thus plugging the vessels, and by coagulating 
the albumin in the tissues, with the effect of constricting the 
vessels. Weak solutions, moreover, are cooling to the skin in 
febrile conditions, and hence they are classed also as refriger- 
ants. Citric acid is added to tablets of corrosive mercuric chlor- 
ide so that when these are dissolved in making solutions the 
antiseptic shall penetrate into the tissues. Tartaric acid is used 
for the same purpose. As most living matter is neutral or 
slightly alkaline in reaction, and appears to be incapable of ex- 
isting in acid media, the acids are protoplasm poisons and anti- 
septics of some power. 



THE ACIDS. 333 

Alimentary Canal — In the mouth, oesophagus and stomach 
complete destruction of the mucous membrane results from the 
corrosive action of strong acids wherever they come in contact 
with the membrane. As in the case of the caustic alkalies, per- 
foration of the oesophagus or stomach may be produced, causing 
immediate death, with symptoms of shock and collapse, or if the 
corrosion does not go to this extent, cicatrices may result which 
eventually lead to a fatal termination. While hydrochloric and 
the stronger organic acids are capable of causing corrosion of 
the mucous membranes, this is not usually so extensive as that 
produced by sulphuric and nitric acid. In the mouth the diluted 
acids have a characteristic sour and pungent taste, and, as it 
is popularly expressed, " set the teeth on edge." They also soften 
the dental enamel. The saliva being alkaline, they augment its 
secretion, and thus serve to allay thirst by keeping the mouth 
moist. In both the mouth and throat they cause an astringent 
feeling in consequence of their coagulating the superficial layers 
of proteids. When the gastric juice is deficient in acid, acids 
taken after a meal, by remedying this, assist digestion, but it 
seems to be the case that if given before or during meals they 
tend to check the flow of the gastric juice. As the latter, when 
normal, contains about 0.2 per cent, of hydrochloric acid, this 
acid, so far as both experimental and clinical results at present 
indicate, is undoubtedly the best for administration when the 
amount of acid secreted by the gastric mucous membrane is 
deficient. Recent researches have shown, however, that pepsin 
is excreted in actual combination with the hydrochloric acid, so 
that it would seem to be impossible to completely replace the 
deficiency of acid in the stomach by giving hydrochloric acid 
by the mouth. The prolonged treatment of animals with acids 
has been found to be followed by anaemia and loss of flesh and 
strength, a result which is thought to be attributable to the dis- 
turbance of the digestion induced, rather than to any specific 
action of the acids. If free acid penetrates into the intestinal 
canal it acts as a very powerful irritant and produces increased 
peristalsis, but as acids given by the mouth are usually absorbed 



334 PHARMACOLOGY AND THERAPEUTICS. 

before passing the pylorus, this cathartic action is practically 
seen only when acids are generated in the intestine itself. As 
a rule, acids quickly become converted into neutral salts, but 
some, especially sulphuric, preserve, it is said, their astringent 
action in the intestine. According to some authorities, the in- 
creased flow of pancreatic juice and of bile which has been 
ascribed to acids is probably too small to be of any value, but 
others are convinced that they do materially increase the amount 
of bile poured into the intestine (this being notably the case 
with nitric acid), while nitrohydrochloric acid is not only a 
cholagogue, but also a hepatic stimulant of considerable power, 
causing actual increase in the activity of the cells of the liver, 
and not merely evacuation of the gall bladder. 

Absorption and Excretion. — Generally the acids are absorbed 
from the alimentary canal with considerable rapidity. • The 
salts formed in the blood and tissues after their absorption are 
quickly excreted by the kidneys. The latter, it is found, retain 
as much alkali as possible in the body, and the result is that they 
excrete the salts in an acid form, and perhaps some free acid. 
Consequently, irritation of the kidneys is sometimes induced, 
with albumin and even blood in the urine, which is rendered 
more acid than usual and causes a sensation of heat and smart- 
ing in the bladder and urethra. Nitric acid, however, is stated 
to be excreted to a small extent as ammonia, and hence to 
slightly increase the alkalinity of the urine. The alkalinity of 
the latter is also increased by acetic, citric and tartaric acids, in 
consequence of their being converted into alkaline carbonates in 
the blood; while lactic acid is either so converted or passes out 
as carbon dioxide in solution in the urine. The acids in general 
increase the ammonia of the urine (the total nitrogen being 
pretty constantly increased to a moderate extent) at the ex- 
pense of the urea, which is accordingly somewhat decreased. 
Just as the secretion of the acid gastric juice is stimulated by 
alkalies introduced into the stomach, acids appear to have the 
power of stimulating alkaline secretions. 

Blood. — Acids may have the effect of reducing the alkalinity 



THE ACIDS. 335 

of the blood, but the reaction of this fluid must necessarily re- 
main slightly alkaline throughout life. It is found that if suffi- 
cient acid be given to an animal to neutralize the alkalies of 
the body, it dies before the blood becomes neutral, although after 
death the latter may be found to be alkaline. Experimentation 
has shown that the diminution of the alkalinity of the blood 
which results from the administration of acids is much more 
pronounced in herbivorous animals than in man and the car- 
nivora; so that in these last no serious symptoms arise from 
this cause. In rabbits the blood-pressure is much lowered by 
the acids, from depression of the vaso-motor centre and the 
heart, and if the poisoning is pushed, the alkalinity of the blood 
becomes so greatly reduced that the tissues are unable to rid 
themselves of their carbon dioxide, and fatal collapse results; 
the heart continuing to beat for some time after the respiration 
has ceased. Even in the last stage of intoxication the injection 
of sodium carbonate, in consequence of the alkali thus supplied 
to the blood and tissues, will have the effect of bringing about 
a rapid recovery. It has been found that the red blood-cor- 
puscles are increased in size by the addition of small quantities 
of acid outside the body, and the amount of phosphates in these 
cells is believed to be increased by the administration of phos- 
phoric acid. In chlorosis it is stated that the number of the 
red corpuscles will be increased by hydrochloric acid, though 
the amount of haemoglobin remains unaltered. 

Therapeutics of Sulphuric, Nitric, Hydrochloric, Phos- 
phoric, Acetic, Citric, Tartaric and Lactic Acids. 
External. — Owing to their marked affinity for water, it is 
difficult to limit the local action of sulphuric and phosphoric 
acids, and consequently nitric acid is much more commonly em- 
ployed as a caustic. It is the preferred escharotic for venereal 
sores, warts, poisoned wounds, sloughing, phagedena and can- 
crum oris, and may be advantageously applied in a variety of 
other conditions, such as uterine ulceration, haemorrhoids and 
prolapse of the bowel. In the form of a foot-bath or lotion 



336 PHARMACOLOGY AND THERAPEUTICS. 

diluted nitric acid is useful in the treatment of chilblains, and 
its addition to the bath has been found of service in such skin 
diseases as impetigo, lepra and acne. Nitric acid is used as 
Heller's test for determining the presence of albumin in the 
urine. At present his process is reversed, i. e., the urine is 
added to the acid. Glacial acetic acid is successfully used for 
warts, corns, ulcers, lupus, epithelioma and nasal hypertrophies, 
as well as for ringworm and other forms of tinea. If much 
pain is occasioned it may be more or less diluted. A mixture 
of 30 parts of acetic acid with 2 parts of salicylic acid is a 
good application for venereal warts. Hydrochloric acid is 
sometimes applied to septic wounds, dissecting wounds, and bites 
of rabid animals, and in combination with pepsin has been 
utilized for the removal of carious and necrotic bone. The un- 
diluted acid is used to destroy warts on the hands of children, 
and has been successfully employed as a counter-irritant in 
sciatica. Three or four coats of it are painted with a small 
brush along the course of the nerve, after which the part is 
wrapped up in cotton. The application may be repeated in 
twenty-four or forty-eight hours, as required. Mixed with an 
equal proportion of honey it has been used as a topical applica- 
tion in diphtheria, care being taken that it should be confined 
strictly to the diseased surface. It has also been recommended 
as an addition to baths in such skin affections as pityriasis and 
tinea. Lactic acid has been advocated as a solvent of false mem- 
brane in diphtheria and croup, though its value in these diseases 
is somewhat problematical. Equal parts of lactic acid and water 
may be applied with a mop, and glycerin is sometimes added 
to the solution. It may also be used as a spray, of the strength 
of 1 to 8. Lactic acid is employed perhaps more frequently than 
any other drug as a local application in tuberculosis of the 
larynx. It is customary to begin with the following: lactic 
acid, 2 ; water, 1 ; glycerin, 1 ; which is applied with a brush. 
The strength of the solution is then gradually increased until 
at length the pure acid is used. Lactic acid is also used as a 
local application for other laryngeal growths, as well as for 



THE ACIDS. 337 

tubercular ulcerations of the tongue and other accessible parts, 
and for caries, lupus and epithelioma. In the external lesions 
of tuberculosis gauze tampons soaked in lactic acid are some- 
times applied, while for tubercular fistulae gelatin bougies con- 
taining the acid may be resorted to. They are composed of a 
paste made by gently heating 50 gm. (13 dr.) each of gelatin, 
lactic acid, and water, and then adding 30 gm. (1 oz.) of 
menthol ; after which the bougies are covered with a coating of 
collodion. In a 20 to 40 per cent, solution lactic acid has proved 
of service in the treatment of suppurative otitis and ulcers of 
the nasal fossa. Any well-diluted acid may be applied to arrest 
slight bleeding, as from leech-bites, piles, etc. Dilute vinegar 
will often answer, but sulphuric acid is particularly useful for 
this purpose, and its astringent effect is also made use of 
locally in the night-sweats of phthisis. Vinegar, properly di- 
luted, is often employed as a refrigerant for bathing the skin in 
fever. In chronic cystitis and phosphatic deposits a very weak 
solution of nitric acid (.06 c.c. ; 1 1U to 30 c.c. ; 1 fl. oz.) has been 
injected with advantage. On account of the intolerance of the 
bladder, such injections should be permitted to escape imme- 
diately. 

Internal. Alimentary Canal. — In consequence of the in- 
jurious effects of acids upon the teeth, it is better that they 
should be taken through a glass tube. Diluted sulphuric 
acid is used to a considerable extent as a prophylactic and 
remedy for lead poisoning, and as a prophylactic measure a 
lemonade made with sulphuric acid is quite commonly taken 
by those employed in lead works and paint factories. This 
treatment is recommended on the ground that the lead taken 
into the system is by this means changed to the insoluble sul- 
phate and is thus less easily absorbed; but it is a fact that 
poisoning may be induced by lead sulphate, so that the utility 
of the measure would seem to be somewhat doubtful. It has 
been found in practice however, that dilute sulphuric acid is 
effective in the treatment of lead-colic and that the constipa- 
tion due to lead is relieved by a combination of sulphuric acid 
23 



338 PHARMACOLOGY AND THERAPEUTICS. 

and magnesium sulphate, while the lead-cachexia is much bene- 
fited by sulphuric acid given in association with quinine and 
ferrous sulphate. On the other hand, sulphuric acid is of no 
service in removing the effects of lead upon the nervous sys- 
tem. Aromatic sulphuric acid, sufficiently diluted with water 
and syrup, makes a pleasant cooling drink for fever patients. 
In gastric and intestinal hemorrhage it acts directly in part, and 
may therefore prove useful, though its action is sometimes dis- 
appointing; and on account of its astringent effect it is often 
of great value in diarrhceic conditions. A combination of aro- 
matic sulphuric acid with opium is considered one of the 
most elficient remedies for summer diarrhcea and cholera, and 
in the treatment of dysentery dilute sulphuric acid may be pre- 
scribed with advantage in association with magnesium sulphate 
and morphine sulphate. Sulphuric acid, being more decidedly 
astringent, is as a rule, to be preferred to nitric and hydro- 
chloric acids in the treatment of diarrhcea, but the latter are 
useful also, and the mineral acids as a class are very efficient 
remedies in summer and colliquative diarrhcea. Whenever the 
stools are painless, watery, of a light color, and alkaline in 
reaction, these agents are indicated. Hope's camphor mixture 
has long been held in repute in such conditions, but it is said 
that when made according to the formula now generally in use 
(Nitric acid 2 c.c. ; y 2 fl. dr.; tincture of opium, 1.20 c.c. ; 
20 Ul ; camphor water, 120 c.c; 4 fl. oz.) ; it is not nearly so 
serviceable as Hope's original formula, in which the acid em- 
ployed was nitrous acid. Prepared in the original way and used 
while fresh, the mixture is regarded as a very efficient, though 
somewhat disagreeable, remedy in serous diarrhceas, as well as 
chronic dysentery connected with disordered secretion of the 
liver and other glands of the alimentary canal. 

As regards the action on the economy of the three prin- 
cipal mineral acids, the general statement has been made 
that sulphuric more promotes astringency, nitric, secretion, 
and hydrochloric, digestion. As previously remarked, hy- 
drochloric acid is the one most appropriate for rectify- 






THE ACIDS. 559 

ing a deficiency in acidity in the gastric juice. In dys- 
pepsia due to this cause it is the most valuable remedy 
which we at present possess, but in many instances the nitro- 
hydrochloric acid is also of great service. For the purpose men- 
tioned these acids have the best effect when taken a little while 
after eating. A very useful combination consists of nitro- 
hydrochloric acid with tincture of nux vomica and some such 
other stomachic tonic as the compound tincture of gentian. Hy- 
drochloric acid is sometimes useful, in association with other 
remedies, in cases of diarrhoea which are characterized by ex- 
cessive putrefaction of the intestinal contents. As a result of 
its administration the double sulphates of the urine are in 
many instances lessened: so that it would seem probable that it 
has the effect of disinfecting the stomach contents, as the hydro- 
chloric acid of the gastric secretion does normally. In the 
variety of dyspepsia in which acid eructations, pyrosis, and 
heartburn occur acids are of decided service, particularly hydro- 
chloric and phosphoric, and they should then be administered 
before meals. It is said that hydrochloric acid prevents the 
lactic fermentation in I to 1,000 dilution, and that in addition 
to its action on the digestive ferment it increases the peristalsis 
of the stomach. Hydrochloric acid is given to a very consider- 
able extent in typhoid fever, where by increasing the secretion 
of mucus it relieves the dryness of the tongue and fauces, and 
where it also no doubt tends to disinfect the intestinal contents. 
In this and other fevers it is believed to be indicated for the 
reason that the normal secretion of hydrochloric acid is much 
diminished when the temperature is raised. It may often be 
advantageously administered in beef-juice. If the diarrhoea is 
troublesome, sulphuric acid may be given in its place. Hydro- 
chloric acid is sometimes of service also in phthisis ; serving to 
supply to the digestive fluids a material in which they are 
deficient (both acid and pepsin in the gastric juice being re- 
duced in this disease), and also to disinfect to some extent the 
alimentary canal. Xitrohydrochloric acid is not, as a rule, so 
efficient as hydrochloric in ordinary dyspepsia. Still, in many 



340 PHARMACOLOGY AND THERAPEUTICS. 

instances it seems to act very satisfactorily, and it is particularly 
indicated when the biliary function needs stimulating. Its 
special value is believed to be in hepatic disorders and jaundice. 
Its mode of action in such conditions is not definitely known, but 
its peculiar composition may possibly afford some explanation. 
This acid contains not only nitric and hydrochloric acid, but 
a number of decomposition products, such as chlorine, nitroxy- 
chloride (NOC1), and nitrous acid. The acids, as is well 
known, are incapable of acting as such except in the alimentary 
canal, but it may be that some of the other constituents of this 
compound, as the chlorine, for instance, have a specific effect on 
the liver. Mucous duodenitis and catarrh of the gall-ducts ac- 
companied by jaundice and jaundice of malarial origin are 
among the affections which have been found to be benefited by it, 
and the experience of physicians practising in tropical countries 
has been favorable to its use in chronic affections of the liver, 
as well as in dysentery and dropsy of hepatic origin. In hepa- 
titis the acid is sometimes not only given internally, but applied 
externally, in the form of a foot-bath or general bath or of a 
compress placed over the liver. It is scarcely possible, however, 
to suppose that it can be absorbed in any quantity from the 
skin; so that any benefit which may be attributable to such ex- 
ternal application would seem to be principally due to the 
counter-irritation caused by it. In acute hepatic diseases and 
such chronic affections as cirrhosis and waxy degeneration 
nitrohydrochloric acid is not thought to be of sevice, as a rule, 
though some authorities advise that it should be tried in the 
early stages of cirrhosis, while the liver is still enlarged. In 
some cases apparently of this character great benefit, it is said, 
has been derived from its use. It is also stated that the wearing 
around the body of a flannel bandage soaked in a solution of 
the acid and covered with oiled silk is serviceable in the first 
stage of cirrhosis, as well as in chronic hepatitis and jaundice. 
Phosphoric acid is sometimes used to make cooling draughts 
in fever, as well as to relieve the thirst in diabetes. Acetic acid 
in the form of vinegar is a popular remedy for obesity. Its 



THE ACIDS. 341 

free use, however, is apt to be attended with more or less 
serious consequences, as it reduces flesh merely by interfering 
with the digestion. The prolonged administration of large quan- 
tities of acids usually proves irritant, and thus, by setting up a 
certain amount of gastritis, hinders the digestion and absorption 
of food. In order to allay the thirst of fever patients lemon 
juice or citric acid itself is used to stimulate the secretion of 
saliva and keep the mouth moist, and lemonade is a common 
beverage in febrile diseases. One or the other of these sub- 
stances thus frequently serves as the basis for cooling drinks, 
and the acid is largely employed, together with alkaline carbon- 
ates, in the preparation of effervescing mixtures which are use- 
ful as gastric sedatives. Citric and tartaric acids also form 
ingredients of various granular effervescent preparations. 
Lactic acid is only occasionally used in the treatment of dys- 
pepsia, as hydrochloric acid is generally much more satisfac- 
tory. At one time, however, under the impression that lactic 
acid was the normal acid of the gastric digestion, it was quite 
extensively employed. 

Remote Effects. — With the exception of citric, tartaric and 
acetic acids, the remote effects of the acids are of comparatively 
little therapeutic importance. Aromatic sulphuric acid was at 
one time quite largely relied upon for checking profuse sweat- 
ing, especially the night-sweats of phthisis. It is occasionally 
so employed with advantage at the present day, but when it is 
used care should always be taken that it is not allowed to inter- 
fere with the digestion. Sulphuric acid was also highly 
esteemed formerly as a remote haemostatic, but is not very often 
used in this capacity now, though some still profess to find it 
serviceable in certain forms of metrorrhagia. In haemoptysis 
it is unquestionably inferior to other remedies. Nitric acid is 
stated to have been at times used with success in the treatment 
of intermittent fever, in which, in order to obtain a curative 
effect, it is insisted that it should be given in full doses every 
four to six hours. This acid has also been found of service, 
after an arrest of the paroxysms of intermittent fever by 



34 2 PHARMACOLOGY AND THERAPEUTICS. 

quinine, in removing the hepatic congestion and the changes in 
the glandular apparatus of the intestines induced by the fever- 
movement. Under these circumstances it is advised that it 
should be combined with the bitters or used instead of aromatic 
sulphuric acid in the preparation of Infusum Cinchonse, for- 
merly official. Chronic bronchitis and hoarseness and the apho- 
nia of singers and public speakers may sometimes be relieved by 
dilute nitric acid in doses of .60 c.c. (10 ni). Both nitric and 
nitro-hydrochloric acids have been used, internally as well as in 
the form of baths, in such diseases of the skin as impetigo, acne 
and erythema nodosum, while sulphuric acid, also employed in- 
ternally and locally, is said to be more or less effective in lichen, 
prurigo, and itching conditions in general. When uric acid is 
in excess in the urine from faulty digestion and assimilation, 
nitric acid is often of great service; the excess of uric acid 
disappearing in consequence of the foods being more adequately 
prepared for admission into the blood. The mineral acids, and 
particularly hydrochloric, have been proposed as remedies for 
acute rheumatism, and tincture of ferric chloride is undoubtedly 
sometimes of benefit in that disease. Lime juice was formerly 
a popular remedy in acute rheumatism, but little can be said 
in its favor. Nitrohydrochloric acid is usually a very efficient 
remedy in oxaluria, a condition which seems to be dependent 
upon defective primary assimilation and is characterized by 
general malaise, a feeling of weakness, great mental depression, 
a sallow complexion, and often eructations of offensive gas, 
together with the presence in the urine of crystals of calcium 
oxalate. It has at times been successfully employed in chronic 
syphilis. Cases occasionally occur in which, in spite of the 
administration of mercury and potassium iodide, specific lesions 
persistently reappear, particularly in the mouth, and it is in 
this class of patients that benefit may sometimes be hoped for 
from the use of nitrohydrochloric acid, although it is in general 
vastly inferior to both of the remedies mentioned in the treat- 
ment of syphilis. Citric, tartaric and acetic acids may be given 
to increase the alkalinity of the blood and to alkalize the urine 



THE ACIDS. 343 

or render it less acid. For an effervescent solution of citric 
acid about 8 parts of the acid may be prescribed along with 7 
parts of sodium bicarbonate, with directions to dissolve the two 
powders separately, mix the solutions, and drink while effer- 
vescing. In large quantities this mixture acts as a saline 
cathartic; in smaller quantities it has the alkalizing effects just 
stated. There is probably no doubt as to the value of lemon and 
lime juice in the prophylaxis and treatment of scurvy. This, 
however, it is stated, is not due to the citric acid, but to some 
unknown property of the fruit juices. Orange juice has proved 
completely successful in the cure of infantile scurvy. It has 
been a common practice to give phosphoric acid to anaemic and 
feeble children for the ostensible purpose of improving the con- 
dition .of the blood and assisting the growth of bones, and to 
employ it in cachectic conditions somewhat generally, on the 
theory that these were due to a deficiency of phosphates in the 
foods and tissues. It has never been shown to be of any benefit, 
however, and experiments seem to have demonstrated that the 
animal tissues are unable to build up phosphorus compounds 
from the inorganic phosphates. Lactic, as well as phosphoric 
acid, has proved useless in the treatment of diabetes, and there 
is reason to believe that the latter may even be injurious in 
this disease. Mineral acids, if their administration is too pro- 
longed, tend to impair the appetite and disturb digestion, causing 
toothache and gastric oppression, and sometimes salivation and 
diarrhoea. In addition, they are liable to produce loss of flesh, 
paleness of the skin, and anaemia. If taken for long periods in 
comparatively large quantities they may induce degenerative 
changes in such organs as the heart, liver and kidneys, as well 
as give rise to the production of methaemoglobin in the blood. 
The prolonged use of nitric acid may occasion erosion of the 
gums and tongue, with loosening of the teeth. 

TOXICOLOGY. 

In toxic doses all these acids are severe gastro-intestinal irritants. 
Tartaric, citric, and lactic acids are very rarely taken as poisons. 



344 PHARMACOLOGY AND THERAPEUTICS. 

Symptoms. — There are intense, burning pains in the mouth, throat, 
stomach and abdomen, difficulty in swallowing, extreme thirst, and vio- 
lent vomiting; the ejected matter containing blood and sometimes shreds 
of mucous membrane. Not infrequently there is diarrhoea, the stools 
showing a dark discoloration from the presence of blood. Some of the 
acid is likely to get into the larynx, causing swelling and consequent 
dyspnoea, from obstruction to respiration. Evidences of shock and 
collapse quickly develop. The respiration is shallow, the pulse rapid 
and weak, and the skin, which shows marked pallor, covered with a 
cold sweat. The temperature falls below normal, and death usually 
occurs within a few hours. When fuming acids are swallowed and espe- 
cially in poisoning with hydrochloric acid, the irritant vapor, passing 
into the respiratory passages, may cause spasm of the glottis or oedema 
of the larynx, with the result of an immediately fatal issue from 
asphyxia. It has been found that as small a proportion of hydrochloric 
acid vapor as i part in 20,000 of air causes sneezing and pain in the 
throat and chest. 

Post-mortem. — There are the characteristic evidences of corrosive 
poisoning in the mouth, oesophagus and stomach, with or without per- 
foration, and sometimes extending into the intestine. The sloughs re- 
sulting from the destruction of the mucous membrane are of a whitish- 
gray color, and haemorrhages are frequently met with. When death 
has been delayed for some time fatty degeneration of the heart, mus- 
cles, liver or kidney may be found, and in these cases a form of necro- 
sis of the renal cells has sometimes been observed. 

Treatment. — Alkalies should be given at once to neutralize the acid, 
though there is a possibility that the stomach may be ruptured by the 
carbon dioxide gas generated from the combination thus formed. The 
best antidote is the insoluble magnesium oxide or carbonate, because 
these are not themselves corrosive, but if neither is procurable, al- 
most any accessible alkali may be resorted to, such as lime, chalk, soap 
or wood ashes. Then demulcents may be given, such as milk, white 
of egg, oil and flaxseed tea, which are useful in protecting the walls 
of the oesophagus and stomach ; and the acid may be rendered less cor- 
rosive by diluting it with large quantities. If strong sulphuric or nitric 
acid has been swallowed, the stomach-tube should not be employed, 
on account of the danger of its extremity passing through the softened 
walls of the gullet or stomach ; otherwise the stomach should be washed 
out. Morphine may be injected hypodermatically to relieve pain, and 
brandy or other stimulants used in the same way to counteract collapse. 



THE ACIDS. 345 

CHROMIUM SALTS. 

1. CHEOMII TRIOXIDUM (Acidum Chromicum, U. S. P., 1890). 
• -Chromium Trioxide. (Chromic Acid. Chromic Anhydride.) 

2. POTASSII DICHROMAS (Potassii Bichromas, U. S. P., 1890). 
-Potassium Dichromate. Dose, 0.010 gm. (10 milligm.) ; y 5 gr. 

Action of Chromium Trioxide. 

External. — Combining, as it does, the action of a metallic 
oxide, an acid, and a strongly oxidizing agent, chromium triox- 
ide is a powerful caustic. By reason of its oxidizing power it is 
also an energetic deodorant and disinfectant. When applied in 
substance it corrodes the skin, as well as other tissues, but it 
causes much less pain than the more penetrating caustic potash. 
Even in dilute solution it is an irritant to the skin, producing 
ulcerations and other lesions, and workmen in factories where 
chromic acid is used are liable to suffer from perforation of the 
nasal septum from the local action of the acid applied acci- 
dentally upon the fingers. 

Internal. — The symptoms produced by large quantities are 
those of gastro-intestinal corrosion, intense pain in the throat 
and stomach, vomiting and purging, with blood in the vomited 
matter and the stools, collapse, and frequently death. Post- 
mortem the lesions met with are those of corrosive poisoning, 
and the mouth and throat show a characteristic yellow dis- 
coloration. In mammalian animals the administration of the 
drug elicits effects similar to those produced by the metals in 
general. Weakness and slowness in the movements are caused, 
and these are followed by albuminuria, and later by diarrhoea 
and vomiting. Sometimes twitching of the muscles or even con- 
vulsions are observed, and then the weakness passes into gen- 
eral paralysis. The heart appears to be little affected, but the 
blood-pressure falls. After death the stomach and intestine 
are found congested, while the mucous membrane is necrosed 
and ulcerated in some parts and covered with ecchymoses in 
others. Haemorrhages are also found in other organs, and 
particularly in the cardiac wall, and parenchymatous nephritis is 



346 . PHARMACOLOGY AND THERAPEUTICS. 

met with. In chronic poisoning interstitial nephritis is said 
to occur. Chromium trioxide is readily absorbed from the 
stomach and intestine. It appears to be excreted principally 
through the kidney, and to a less extent through the intestinal 
epithelium. 

Therapeutics of Chromium Trioxide. 
External. — Chromium trioxide is never employed internally. 
It is used, generally in the strength of 1 per cent., to harden 
cat-gut and kangaroo tendon for surgical purposes. A lotion 
of the same strength is used in Germany to toughen the feet of 
marching soldiers. On account of its disinfectant properties it 
is employed in the form of a lotion, 1 to 40, or even stronger, 
for cleansing foul ulcers and sores and as a local application, 
in various dilutions, in gonorrhoea, leucorrhcea, ozaena, severe 
ulcerations of the mouth, etc. It is also sometimes used 
as a gargle, and for this purpose the solution should not 
be stronger than 1 to 480. The Liquor of the B. P., 
which is one part of chromic acid in 3 o*f water, may 
be employed as a caustic to destroy warts, condylomata 
and other small growths. As the escharotic action tends 
to spread, it should be used with caution. The adjacent sur- 
face should be protected with ointment, and the excess of acid 
promptly removed with an alkaline wash. A solution of chro- 
mium trioxide of the strength of .60 gm. (10 gr.) to 30 c.c. 
(1 fl. oz.), applied once or twice a day, is an excellent remedy 
for enlarged tonsils and syphilitic mucous patches. It has also 
been used in endocervicitis, uterine haemorrhage, hypertrophies 
of the nasal passages, and some malignant growths, and has 
been injected into haemorrhoids. For parasitic skin diseases, 
such as sycosis, lupus and tinea circinata, a solution ten times 
the strength of this may be employed. An ointment containing 

1 gm. (15 gr.) to 30 gm. (1 oz.) is serviceable in favus, after 
the crusts have been removed, and a wash of the strength of 

2 gm. (30 gr.) to 500 c.c. (1 pint) of water, and also contain- 
ing tannic acid, hydrated chloral, and morphine sulphate, has 



THE ACIDS. 347 

been recommended for chronic ulcers. A I per cent, solution 
in water, it is stated, has been found valuable in cases of viper 
bites. The following treatment has proved successful in ranula 
and cystic goitre: The tumors are opened and their contents 
washed out, and, after haemorrhage has ceased, a saturated 
solution of chromium trioxide is freely applied to several points 
of the cyst wall. 

Action of Potassium Dichromate. 

External. — Like chromium trioxide, it is an irritant caustic. 
Its escharotic, as well its antiseptic, action, however, is some- 
what less energetic than that of the trioxide; though the work- 
men engaged in making it are liable to painful ulcerations of 
the hands. Eczema of the hands, moreover, is said to occur in 
those who prepare the dichromate solution used for dyeing pur- 
poses, and material dyed with the latter may produce ulceration 
of the integment. 

Internal. — The effects are essentially the same as those of 
chromium trioxide, and if the quantity swallowed is sufficiently 
large, death may result. Less than 30 gm. (1 oz.) has caused 
unconsciousness in five minutes, with death thirty-five minutes 
later. In two recorded fatal cases of poisoning by it the 
amounts taken were respectively 8 and 15 gm. (2 and 4 dr.). 
In doses of 0.05 gm. (^ gr.) it acts as an emetic. 

Therapeutics of Potassium Dichromate. 

External. — It is used as a caustic for warts, venereal ulcers, 
and mucous patches. Its solution has also been employed as 
a disinfectant wash for sloughing wounds. 

Internal. — It has been recommended for the treatment of 
gastric catarrh and gastric ulcer in dose of from .005 to .01 gm. 
(tV t0 i 8 T -)> gi yen thrice daily on an empty stomach, and is 
reputed to relieve nausea, vomiting and pain. In catarrhal con- . 
ditions of the respiratory tract it has been advocated as an ex- 
pectorant. It has been employed successfully in children, in 
small doses (0.003 g m - ; yV S r - f° r an infant of one year), 
every hour, and it is advised that when the respiration is 



348 PHARMACOLOGY AND THERAPEUTICS. 

seriously embarrassed, the dose should be repeated every fifteen 
to thirty minutes. Favorable results have been reported from 
its use in cases of haematochyluria, some of which depended on 
the presence of filariae, and it has been recommended for the 
treatment of pernicious malarial anaemia. It has also been em- 
ployed in syphilis and chronic rheumatism, but without any 
appreciable results. In cases of poisoning by chromium triox- 
ide or potassium dichromate, soap, an alkaline carbonate, or 
magnesia, together with milk, may be given at once, and the 
stomach washed out. 

TURPENTINE. 

1. TEREBINTHINA.— Turpentine. 

Preparation. 
Ceratum Resinae Compositum. — Compound Rosin Cerate. 

2. OLEUM TEREBINTHINA.— Oil of Turpentine. 

Preparations. 

1. Oleum Terebinthinse Rectificatum. — Rectified Oil of Tur- 
pentine. Dose, 1 c.c; 15 ni. 

2. Emulsum Olei Terebinthinse. — Emulsion of Oil of Tur- 
pentine. Dose, 4 c.c; 1 fl. dr. 

3. Linimentum Terebinthinse. — Turpentine Liniment. 

Unofficial Preparations. 
Sanitas. — Sanitas. 

Terebinthina Chia. — Chian Turpentine. Dose, .30 to 1.20 
gm.; 5 to 20 gr. 

Action of Turpentine. 
External. — Oil of turpentine has the characteristic action of 
the volatile oils in general. On the skin it acts as a rubefacient 
irritant, and counter-irritant, and its prolonged application may 
give rise to vesication or even ulceration. The effects are more 
marked if it is applied with 'friction. Under its external use, 



TURPENTINE. 349 

then, we find produced tingling, a feeling of warmth, and 
reddening of the surface, all of which result from the local 
dilation of blood-vessels caused by it. On mucous membranes 
there is found the same irritation, with redness and congestion, 
pain and smarting. Applied to fresh wounds, it is haemostatic, 
contracting the blood-vessels and aiding coagulation. Oil of 
turpentine is a fairly energetic antiseptic, and it is less irritant 
than many of the more powerful ones. It is absorbed from the 
unbroken skin. 

Internal. Alimentary Canal. — Kept in the mouth, it causes 
the same redness and irritation of the mucous membrane, and 
is apt to excite a reflex secretion of saliva. In the stomach it 
gives rise to a feeling of warmth and comfort and causes some 
reflex stimulation of the heart. It also acts as a carminative, 
accelerating peristalsis and promoting the expulsion of gas. 
Whether the volatile oils have any direct action on the gastric 
secretion is still a disputed point. It has been recently shown 
that from the intestine, as well as the stomach, absorption occurs 
more rapidly in the presence of slight irritants, such as these 
oils. It is still unknown whether the peristaltic movements of 
the bowel are increased by them, though turpentine certainly 
appears to have a marked stimulating effect upon the muscular 
coat of the intestine. It diminishes flatulence and distention, 
and its antiseptic action may be concerned in the production of 
this result. It is anthelmintic, and in sufficiently large doses 
cathartic, the faeces often containing blood. 

Circulation. — Our knowledge of its action on the circulation 
is very imperfect, and the statements of various observers re- 
garding this differ greatly. It appears to produce a very 
slight rise of arterial pressure, increased pulse-rate, and in- 
creased cardiac force. The drug is known to have haemostatic 
properties, and this action is no doubt due to its power of con- 
tracting the vessels. After a large dose the stimulation is fol- 
lowed by depression, the action of the heart growing feeble, the 
blood-pressure falling, and the vessels dilating. 

Nervous System. — In its action on the nerve cells oil of tur- 



350 PHARMACOLOGY AND THERAPEUTICS. 

pentine differs from some of the other volatile oils in that 
the preliminary stimulation caused by large amounts is only 
transitory, being quickly followed by marked weakness and 
depression; with heaviness, unsteady gait, and drowsiness. 
Toxic doses are said to cause paralysis of sensory nerves, loss 
of reflex action, insensibility and coma. The depression of the 
respiratory centre in the medulla is preceded by stimulation, 
the breathing increasing in rapidity and volume. 

Respiration. — Oil of turpentine is in part excreted by the 
bronchial mucous membrane, and during the course of this 
excretion it exerts an irritant action on the respiratory pas- 
sages which may be sufficient to lead to bronchitis. Such ex- 
cretion may be at once stimulating and antiseptic, and turpen- 
tine may also diminish the bronchial secretion in a specific man- 
ner. According to some authors it acts as an expectorant, while 
others consider that it diminishes excessive secretion and allays 
cough. It has consequently been suggested that both statements 
may be true in different pathological conditions and with dif- 
ferent doses of the drug. When inhaled, the vapor of turpen- 
tine has an irritating effect on the bronchial mucous membrane, 
just as the oil does when applied directly to mucous membranes 
and to the skin. The disinfecting agency of the drug is shown 
by the fact that turpentine prevents experimental tuberculosis 
in dogs. 

Kidneys. — It is largely excreted by the kidneys. Its action 
upon these organs is more energetic than that of almost any 
other volatile oil, and especially results in diuresis. Large doses 
are very irritant, lessening the amount of urine, rendering it 
highly colored, and in some cases producing albuminuria, 
hematuria, and even total suppression. This irritant action is 
not confined to the kidneys, but extends to the whole genito- 
urinary tract. There is much aching in the loins, with spas- 
modic pain in the ureters, a sensation of heat in the perineum, 
a constant desire to pass water, without the ability to do so, 
in consequence of the urethral spasm, and a general condition 
of strangury. Priapism may be induced, and an intolerable irri- 






TURPENTINE. 351 

tation may affect all the pelvic organs. In especially susceptible 
individuals symptoms of this character may be caused by even 
moderate amounts of the drug. A characteristic effect of tur- 
pentine is the odor of violets which it imparts to the urine. 

Skin. — There is reason to believe that it is excreted to some 
extent by the skin glands. In persons with an idiosyncrasy to 
turpentine erythematous, papular or vesicular eruptions may 
be caused by both its internal and external use. 

It seems probable that oil of turpentine is excreted in part 
by the intestine and in the bile, milk, and other secretions. 

Temperature. — It appears to have a slight antipyretic action. 

Old oil of turpentine, containing oxygen, is an antidote to 
phosphorus {see phosphorus). The statement has been made 
that this and the French oil are preferable in other respects; 
but this seems questionable. 

Therapeutics of Turpentine. 

External. — Oil of turpentine is highly esteemed as a counter- 
irritant in bronchitis, pneumonia, pleurisy, peritonitis, osteo- 
arthritis, and other inflammatory conditions, and in such pain- 
ful disorders as pleurodynia, neuralgia, myalgia, lumbago and 
old rheumatic pains. It is often employed in the form of a 
stupe, which consists of a piece of flannel heated by steam or 
by being wrung out of hot water, on the surface of which a 
few drops of turpentine are sprinkled just before application. 
Turpentine stupes should be removed as soon as they cause 
pain. Spongiopiline may be used in place of the flannel. A mix- 
ture of equal parts of turpentine and yolk of egg is sometimes 
employed for external applications. In peritonitis a combina- 
tion of oil of turpentine with olive oil and mercurial ointment, 
applied warm upon flannel over the abdomen, has been used 
with advantage. The external application of oil of turpentine 
is also sometimes of service in puerperal fever. When friction 
is desired, as in the case of rheumatic joints, it is advisable to 
use turpentine in the form of a liniment, in which it is often 
associated with other substances. The official liniment, for 



352 PHARMACOLOGY AND THERAPEUTICS. 

most purposes, should be diluted. Preparations containing tur- 
pentine are sometimes employed for topical application in in- 
flammatory affections of the pharynx, tonsils and larynx, and 
in diphtheria the oil has been brushed on the affected parts or 
used by inhalation. In this disease it is stated that advantage 
has been derived from the continuous inhalation of a mixture 
composed of i part each of carbolic acid and oil of eucalyptus 
and 8 parts of oil of turpentine; cloths saturated in the fluid 
being hung or laid near the face of the patient, but not allowed 
to come in contact with the skin. Oil of turpentine has been 
used with success in the treatment of severe burns, accompanied 
by constitutional depression, and it is an excellent antiseptic for 
old suppurating wounds. Care must be taken that it does not 
blister the skin. It is sometimes used as a parasiticide for ring- 
worm, and an ointment of turpentine (B. P., soft soap, 37.5; 
distilled water, 125; camphor, 25; oil of turpentine, 325), is said 
to be advantageous in chronic eczema, psoriasis and alopecia 
circumscripta, as well as a good application for indolent ulcers. 
Sanitas (not official), a very pleasant disinfectant, though not 
so strong as phenol, is an aqueous solution of common turpen- 
tine which has been allowed to oxidize in the air. Its active 
antiseptic principle is hydrogen dioxide, and it contains a lit- 
tle thymol. 

Internal. Stomach and Intestines. — For internal use the rec- 
tified oil only should be prescribed. It is not very frequently 
employed as a stomachic, but is used to a considerable extent 
as an intestinal carminative; and flatulence may often be 
promptly relieved by a few drops on a lump of sugar. It is 
regarded as especially indicated in persistent flatulence result- 
ing from a paretic condition of the muscular coat, and it has 
been shown to possess curative power in chronic intestinal 
catarrh. Among the indications for its administration may be 
mentioned a dry and glazed tongue, tympanitic distention of 
the abdomen, and stools which are either fluid or consist of 
scybala mixed with mucus and pale, watery blood. It is thus 
a valuable remedy in subacute dysentery, where it is often given 



TURPENTINE. 353 

in an emulsion with almond oil and opium. In these cases it 
is believed that it gives tonicity to the vessels and to the mus- 
cular fibres of the intestines, arrests the putrefactive and fer- 
mentative processes which take place in the vitiated mucus and 
articles of food, and by increasing the cutaneous capillary cir- 
culation relieves congestion of internal organs. From our 
knowledge of the physiological effects of oil of turpentine it 
would naturally be supposed that it might prove of service in 
typhoid fever, both as a haemostatic and an antiseptic, and in 
many cases of this disease it is found to be of the greatest 
practical value. Here it not only acts as a local stimulant to 
the ulcerated bowel, but also exerts a beneficial influence upon 
the general state of the system. Two conditions or stages 
in the disease have been pointed out in which it is especially 
useful. The first is when at about the end of the second week 
the tongue becomes very dry, red, chapped, and perhaps coated 
in the centre with a brownish fur, and at the same time marked 
meteorism develops. 0.6 c.c. (10 ni) of the oil of turpentine 
given every two hours during the day and every three hours 
in the night will be found in many instances to do away with 
these unfavorable signs. The second is when the ulceration of 
Peyer's patches proves slow to heal, so that there is a constant 
tendency to the recurrence of diarrhoea, and convalescence is 
thus delayed. Here the remedy seems to act almost as a specific. 
It is stated that the typhoid fever bacillus will not develop in 
air containing diluted vapor of turpentine, and dies when the 
air is saturated with the vapor, while thymol appears to be even 
more efficient than turpentine. The intestinal haemorrhage of 
typhoid may also often be successfully treated with oil of 
turpentine. Administered in the form of an enema, in some 
such vehicle as mucilage of starch, it is very effective in reliev- 
ing flatulence of the bowels, and where there is impaction of 
the caecum or rectum castor oil is frequently combined with it 
in the injection. Turpentine has also been used by enema 
as a derivative in insolation or sunstroke and in cerebro-spinal 
meningitis, as well as a remedy for thread-worms. Given in- 
24 



354 PHARMACOLOGY AND THERAPEUTICS. 

ternally, oil of turpentine is efficacious in the treatment of 
tape-worm, but as the dose required for this purpose is large, 
it may produce strangury and other constitutional effects. For 
this reason castor oil or other purgative should be promptly 
administered after it, and many advise that the purgative should 
be combined with it. A combination of equal parts of turpen- 
tine and ether (Durand's remedy) at one time acquired con- 
siderable reputation in the treatment of biliary calculi. While 
during the acute attack of biliary colic it is inferior to other 
remedies, as morphine and hydrated chloral, clinical experience 
seems to have shown that in the after-treatment its occasional 
administration may sometimes be of service as an adjuvant 
to other measures. In yellow fever, puerperal septicaemia, and 
other febrile diseases, as well as in typhoid, oil of turpentine has 
been successfully employed as a stimulant and antiseptic. In 
affections of this class it is recommended that for the intestinal 
complications the dose, as a rule, should be small and frequently 
repeated, while as a stimulant to the vaso-motor nervous sys- 
tem it should be somewhat larger and repeated at somewhat 
longer intervals. 

Circulation. — It is contraindicated where there is active 
haemorrhage and a condition of plethora, in hypertrophy of the 
heart, and when advanced atheroma of the cerebral arteries is 
believed to be present. In the passive haemorrhages in ataxic 
cases, where there is a condition of debility, relaxation of the 
vessels, and an impoverished condition of the blood, it is of 
great service. It may be given in haemorrhages from the 
stomach, bowels, lungs, etc., and is also efficacious in the 
haemorrhagic transudations met with in purpura, scurvy, and 
allied states. 

Respiration. — For the purpose of inhalation turpentine may 
generally be replaced with advantage by the Vapor Olei Pini 
(see p. 356), especially as the latter is much more agreeable, 
but it is occasionally used internally in chronic bronchitis with 
profuse expectoration (especially when the latter has a fetid 
odor), and in gangrene of the lung. It may also be employed 



TURPENTINE. 355 

in pneumonia and capillary bronchitis with marked depression 
of the vital powers and enfeeblement of the circulation, and 
particularly when these affections occur in the course of typhus 
or typhoid fever and similar diseases. Here it is often applied 
externally, as well as given by the mouth. 

Genito -urinary Tract. — Turpentine would no doubt be more 
generally employed than it is in a variety of affections (as it 
unquestionably has a considerable number of useful applica- 
tions), were it not that it is so disagreeable to take, and also 
because of the fact that it is so liable to cause inflammation of 
the kidneys. On the latter account it must always be adminis- 
tered with caution, and it is, of course, entirely contra-indi- 
cated when renal disease is present. An exception as regards 
the latter, however, is sometimes made in the case of chronic 
pyelitis, where the oil of turpentine, as well as those of copaiba 
and cubeb, may have a good effect in changing the condition 
of the mucous membrane and limiting the formation of pus; 
also in hydro- and pyo-nephrosis, where by actual contact it 
may alter the relaxed state of the vessels and the patholog- 
ical secretions of the mucous membrane. In these conditions it- 
should always be given in small doses and its effects watched 
with extreme care. In incontinence of urine, due to atony of 
the muscular coat of the bladder and not to spasm, and in 
chronic cystitis, gleet, spermatorrhcea and prostatorrhcea, when 
the discharges characterizing these affections are the result 
of relaxed conditions, turpentine, in moderate doses, may not 
infrequently be administered with considerable benefit. In all 
these cases it should be borne in mind that, with the exception 
of cantharides, oil of turpentine is the most actively stimulating 
of all the diuretics, so that it must be resorted to only when a 
stimulant effect is called for. It is never employed to increase 
the flow of urine for the purpose of affecting serous effusions, 
being used as a diuretic simply for its local influence upon the 
kidneys. -Excessive diuresis sometimes is apparently dependent 
upon a relaxed condition of these organs, and under these cir- 
cumstances oil of turpentine may be of service. 



356 PHARMACOLOGY AND THERAPEUTICS. 

Chian turpentine (not official) is an oleo-resin obtained from 
Pistacia terebinthus. It has been recommended for the cure 
of scirrhus and other malignant disease, especially of the uterus, 
it being insisted that for this purpose the drug should be pure 
and that its administration should not only be begun early, but 
should be continued for a year after the manifestations of the 
disease have disappeared or the tumor has been removed by 
operation. Its value in cancer, however, has never been satis- 
factorily demonstrated. In doses of from 0.30 to 1 gm. (5 to 
15 gr.) this agent has proved of service in pityriasis rubra. 
It is stated that the solid form is not an eligible method of 
administration when it is to be continued for a considerable 
length of time, as it has been known to accumulate and form 
a mass in the stomach. 

CANADA TURPENTINE. 

TEREBINTHINA CANADENSIS.— Canada Turpentine. (Canada 
Balsam. Balsam of Fir.) 

Action of Canada Turpentine. 
Its action is the same as that of oil of turpentine. 

Therapeutics of Canada Turpentine. 
Under the names of Canada balsam and balsam of fir, as well 
as the deceptive title of " balm of Gilead," Canada turpentine 
has been used to a considerable extent, especially in the treat- 
ment of chronic bronchitis. It is principally employed (in con- 
sequence of its physical property of drying), for forming an 
adhesive varnish. 

FIR-WOOD OIL. 

Unofficial Preparations. 
Oleum Pini. — Oil of Pine. (Fir-wood Oil. Pinol.) 
Vapor Olei Pini. — Vapor of Oil of Pine. 






OIL OF ERIGERON. 357 

Action of Fir-wood Oil. 
The action of oil of pine is the same as that of oil of turpen- 
tine. 

Therapeutics of Fir-wood Oil. 

This oil is used locally or by inhalation. It is much more 
agreeable than the oil of turpentine, and is employed in various 
sprays and inhalations in the treatment of acute coryza, nasal 
catarrh and many diseases of the respiratory passages. It is 
especially useful as a stimulating, disinfectant expectorant in- 
halation in chronic bronchitis or laryngitis. 

OIL OF ERIGERON. 
OLEUM ERIGERONTIS.— Oil of Erigeron. (Oil of Fleabane.) 
Dose, 1 c.c; 15 TT\.. 

Action of the Oil of Erigeron. 
It has the same general effects as oil of turpentine, but is 
less irritant. 

Therapeutics of the Oil of Erigeron. 

While it is less irritant, it is also less efficient than oil of tur- 
pentine. Externally it is often applied to prevent insects from 
injuring the skin. It has been used in diarrhoea, dysentery and 
haemorrhages, in much the same way as oil of turpentine. It 
has the advantage over the latter of being much less unpleasant 
to take, and has been found by some an effective remedy in 
haemoptysis, as well as in menorrhagia and in metrorrhagia, 
when of passive character. In acute congestion of the kid- 
neys it is contra-indicated, but in the strictly chronic forms 
of renal disease it is thought to lessen the waste of albumin, 
and at the same time to improve the general condition of the 
patient. 

TAR. 

PIX LIQUIDA.— Tar. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. 



358 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Syrupus Picis Liquidae. — Syrup of Tar. Dose, 4 c.c; 1 
fl. dr. 

2. Unguentum Picis Liquidae. 

OLEUM PICIS LIQUID^.— Oil of Tar. Dose, 0.2 C.C.; 3 Til. 

Unofficial Preparation. 
Pixol. — Pixol. 

Action of Tar. 

External. — Though its effects are somewhat less pronounced, 
tar is, like oil of turpentine, a local irritant, by reason of its 
action in dilating the blood-vessels. If its application is pro- 
longed, it is likely to induce an eruption of red papules, some 
of which may suppurate, constituting what is known as " tar 
acne." This is sometimes met with in those who work in tar 
or are much exposed to its fumes. When applied over a large 
area, absorption from the skin may give rise to toxic symp- 
toms resembling those of phenol poisoning. In less concen- 
trated form it relieves itching, an effect which has been 
attributed to its reducing the sensibility of the sensory nerve 
terminations. The vapor, when inhaled, has a local antiseptic 
and stimulant action on the respiratory mucous membrane. 
Tar has very valuable antiseptic and disinfectant properties, 
and on account of its cheapness it is especially serviceable for 
the disinfection of excrementa, premises, etc. 

Internal. — In small doses it has the effect of stimulating the 
circulation and increasing the secretions. It is excreted by the 
respiratory mucous membrane and the kidneys, and acts as a 
stimulant and antiseptic during elimination. It is thus both 
a diuretic and expectorant. In large doses it produces head- 
ache, epigastric and abdominal pain, general malaise, indi- 
gestion, vomiting of dark-colored matter, loose black stools, and 
blackish-brown urine, which smells of tar and may contain 
blood or albumin. The urine may possibly be clear when 
passed, but on standing it throws down a dark deposit. The 
symptoms, it will be seen, have considerable resemblance to 
those of phenol poisoning. 



tar. 359 

Therapeutics of Tar. 
External. — Wood tar is the only official form of tar, but coal 
tar is often used in medicine. The prepared form of it is 
made by simply heating and stirring coal tar at 120 F. (48 C.) 
for an hour. The chief use of tar is for the local treatment of 
certain forms of skin disease, and for this purpose it is applied 
in lotions, paints, ointments, plasters, soaps and baths. The 
official ointment is liable to cause more or less irritation, and 
should generally be diluted. In order to prepare an unirritating 
tar ointment, it has been advised that the tar be previously 
allowed to stand for several weeks in a warm place. It will 
be found that it separates into two layers, the upper of which 
is thin and syrupy, and is destitute of irritant properties. 
Liquor Picis Carbonis (not official) is a favorite preparation 
for many skin diseases. It may be made thus : Dissolve rosin 
soap (see Rosin), I, in alcohol, 8; add prepared coal tar, 4; 
digest at 125 F. (51 C.) for two days, allow it to cool, then 
decant and filter. An ointment of 3 parts of lard with 1 of 
this solution may be made. Liquor Picis Carbonis Detergens 
(not official) is an alcoholic solution of ordinary coal tar, which 
is used externally in skin diseases, diluted in 20 parts of water. 
Tar is especially useful in scaly affections, such as psoriasis. 
Among the other skin diseases in which it is serviceable may 
be mentioned lichen, chronic eczema, comedo, sycosis, pemphi- 
gus, prurigo, and lupus erythematosus and vulgaris, as well as 
scabies and tinea. An alkaline tar-water, made by adding tar, 
8 c.c. (2 fl. dr.) and caustic potash, 4 gm. (1 dr.) to water, 
150 c.c. (5 fl. oz.), is a good application in eczema. A weakened 
tar ointment, by reason of its mildly anaesthetic action, is use- 
ful in relieving pruritus ani and other itching affections. The 
tar-water which was formerly official (made by mixing 1 part 
of tar with 4 of water) is an efficient antiseptic application to 
unhealthy wounds or sores. This preparation used with an 
atomizer or vaporized by heat is beneficial in acute pharyngitis 
and laryngitis, as well as in chronic catarrhal affections of 
the air-passages. It has been found of service in winter cough, 



360 PHARMACOLOGY AND THERAPEUTICS. 

and is said to materially lessen the tendency to taking cold. 
Sufferers from chronic bronchitis sometimes derive consider- 
able benefit from the fumes given off from tar which is allowed 
to simmer in a vessel placed on a stove in the room occupied by 
them. In ozsena the inhalation of the fumes of a mixture con- 
taining tar, camphor, potassium iodide, and tincture of iodine, 
placed upon a water-bath, has been recommended. In the 
treatment of haemorrhoids the application of a preparation con- 
sisting of tar, 3, extract of belladonna leaves, 3, and glycerite 
of starch, 30, has been found useful. In some individuals there 
is an intolerance of tar, so that even the smallest quantity will 
be found to excite irritation and cause a papular, eczematous 
eruption. 

Internal. — Except as a remedy for some chronic diseases of 
the skin, tar is used internally almost exclusively as an ex- 
pectorant. Wood tar only is given for bronchial affections, 
and it is in the chronic forms of these that it proves especially 
valuable. It may be prescribed in pill, as the syrup, or as the 
French preparation, Eau de Goudron. Vinum Picis Liquidae 
(not official), which is a saturated solution of tar in sherry wine 
and the dose of which is 4 to 15 c.c. (1 to 4 fl. dr.), is used 
to a considerable extent. An excellent cough mixture consists 
of the syrups of tar and wild cherry, with .003 gm. (-g-^-gr.) of 
apomorphine hydrochloride in each dose. The dose of tar- 
water is 500 c.c. (1 pint) daily. The latter has been found of 
service in some cases of chronic pulmonary tuberculosis; quiet- 
ing cough, checking diarrhoea, and improving the appetite and 
digestion. In chronic diseases of the skin the internal admin- 
istration of wood tar is sometimes a valuable adjunct to local 
treatment, and the action of small doses has been found espe- 
cially favorable in psoriasis and eczema. Tar has also occa- 
sionally been given internally in haemorrhoids and in catarrh 
of the urinary tract. 

Pixol, disinfectant and antiseptic, is a compound made by dis- 
solving green soap in tar and slowly adding a solution of either 
potash or soda in water. It is a syrupy liquid which, in 5 per 



OIL OF CADE. 361 

cent, dilution, has been used for disinfecting linen and washing 
the hands. A 10 per cent, solution is said to be an efficient 
disinfectant of excrementa, and it is extremely cheap. A solu- 
tion of this strength, it is asserted, is fatal to the micro-organ- 
isms of suppuration, anthrax, typhoid fever, and cholera. 

OIL OF CADE. 
OLEUM CADINUM.— Oil of Cade. (Juniper Tar Oil.) 

Action of Oil of Cade. 

It has much the same action on the skin as tar, but its 
preparations have decidedly less odor and are less injurious to 
the clothing. 

Therapeutics of Oil of Cade. 

Oil of cade is too stimulating for most acute eruptions, but 
is used with benefit in chronic eczema, psoriasis, pityriasis 
rubra, lichen, prurigo, and various forms of pruritus. It is also 
an efficient parasiticide in favus and other varieties of tinea. 
It is sometimes applied in full strength and sometimes diluted 
with a bland oil, and is also made into ointments, and especially 
into soaps. A common formula consists of oil of cade, 1 ; soft 
soap, 4; alcohol, 4. An ointment made by melting with it an 
equal part of yellow wax is a stronger and also a more agreeable 
preparation. A mixture of oil of cade in acetone collodion has 
been recommended as having special advantages in psoriasis, 
lichenoid eczema, simple chronic lichen, lichen planus, and in 
nummular and seborrhceic eczemas. " Haarlem oil," which is 
said to be composed of equal parts of oil of cade and oil of 
juniper berries, has had a considerable vogue in chronic affec- 
tions of the kidneys and bladder. As an anthelmintic oil of 
cade has been given in doses of .15 to .30 gm. (3 to 6 ni), 
repeated several times a day. 



362 PHARMACOLOGY AND THERAPEUTICS. 

BURGUNDY PITCH. 

Unofficial Preparations. 

Pix Burgundica (U. S. P., 1890). — Burgundy Pitch. 

Emplastrum Picis Burgundicse (U. S. P., 1890). — Burgundy 
Pitch Plaster. 

Emplastrum Picis Cantharidatum (U. S. P., 1890). — Can- 
tharidal Pitch Plaster. (Warming Plaster.) 

Retinol. — Retinol. (Resinol. Codol.) 

Action of Burgundy Pitch. 
Burgundy pitch is stimulating to the skin, and, applied as a 
plaster, produces itching, redness, and sometimes a papular 
eruption. Upon a delicate integument it may occasion a vesicu- 
lar, or even a pustular, eruption, with superficial ulcers. 

Uses of Burgundy Pitch. 

It is employed as a basis for a number of plasters, and in 
this form it is in general use to protect, sustain and stimulate 
the parts to which it is applied. These plasters are often very 
useful as mild counter-irritants in lumbago and other forms of 
muscular rheumatism, chronic rheumatic swellings, and affec- 
tions of the chest and abdomen; and obstinate cases of sciatica 
are sometimes cured by enveloping the buttock and thigh in a 
Burgundy pitch plaster, and leaving it permanently in place. 
In pulmonary diseases a plaster of proper dimensions gives to 
the chest a greatly-needed mechanical support during the act 
of coughing. The cantharidal pitch plaster is especially service- 
able for its revulsive effect, as its counter-irritant action is 
somewhat greater than that of the simple pitch plaster, though 
less than is caused by a blister. Burgundy pitch has been 
thought to have some special action upon the rectum, and for 
haemorrhoids has sometimes been given in the form of pills. 

Retinol (resinol), a yellowish, oily liquid, is a product ob- 
tained by the distillation of Burgundy pitch. It has consider- 
able antiseptic power and is non-irritating, but is not soluble 



ROSIN. 363 

in water. When applied over a surface it forms a varnish-like 
coating. Its principal use is as a solvent for various alkaloids 
and for such other medicinal agents as iodol, salol, thymol io- 
dide, chrysarobin, cocaine, phenol and phosphorus. The solu- 
tion of phosphorus is said to be very stable and serviceable for 
both internal and external use. Retinol has been applied on 
tampons, with borax and other substances, and also used in 
suppositories, in the treatment of vaginitis, and has been in- 
jected into the bladder, in a 5 to 10 per cent, solution, in sub- 
acute cystitis. It is an excellent vehicle for medicaments in 
diseases of the skin, and in a large number of these affections, 
either alone or as an antiseptic excipient for other substances, 
it is stated to have given good results. It mixes readily with 
fats, oils, lanolin, glycerin and petrolatum. The following has 
been employed as a topical application in diphtheria: Retinol, 
15; camphor, 2; naphthol, 1. In ophthalmological practice re- 
tinol, mixed with lanolin, has been used for conjunctivitis, 
simple or gonorrhceal, and for affections of the lids and tear- 
ducts, as well as for the preparation of dressings and the pro- 
tection of instruments. Internally, retinol has been given, in 
capsules, in the treatment of gonorrhoea. 

ROSIN. 

RESINA. — Rosin. (Resin. Colophony.) Dose, 0.250 gm. (250 
milligm.); 4 gr. 

Preparations. 

1. Ceratum Resinse.— Rosin Cerate. (Basilicon Ointment.) 

2. Ceratum Resinae Compositum. — Compound Rosin Cerate. 

Unofficial Preparation. 
Emplastrum Resinse (U. S. P., 1890). — Resin Plaster. (Ad- 
hesive Plaster.) 

Action of Resin. 
Locally rosin is antiseptic and slightly irritating; internally 
it is antiseptic and astringent in its effects upon the intestines. 
It has the property of preventing the oxidization of fatty sub- 
stances, and thus contributes to the preservation of ointments. 



364 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Rosin. 

Rosin cerate is a good dressing for indolent or unhealthy 
ulcers and wounds, promoting cicatrization and granulation, as 
well as acting as a disinfectant. It is also sometimes applied 
to burns and chilblains. Compound rosin cerate (Deshler's 
salve) is more stimulating, as it contains crude turpentine. 
The chief use of rosin is in plasters, which it renders adhesive 
and more or less stimulating. In some persons the skin is so 
sensitive that the simple Emplastrum Resinae will excite very- 
considerable irritation. Rosin soap is made from rosin, 6; 
caustic soda, 1 ; water, 25 ; which are boiled together in an 
evaporating dish for two hours, after which the soap is 
separated by a strainer and dried on a water-bath. In chronic 
bronchitis and winter cough the fumes from boiling rosin 
may sometimes be inhaled with advantage. Rosin was at 
one time employed in diarrhceal affections, in which it had 
some vogue as a domestic remedy, but is now seldom given in- 
ternally. 

FRANKINCENSE. 

THUS AMERICANUM (B. P., not official).— Frankincense. 

Action of Frankincense. 
It has the same effects as rosin. 

Therapeutics of Frankincense. 
Its toughness and adhesiveness make it a useful constituent 
of plasters. It is an ingredient of Emplastrum Picis (B. P.). 

AMYL NITRITE. 
AMYLIS NITRIS.— Amyl Nitrite. Dose, 0.2 c.c; 3 TTL- 

Action of Amyl Nitrite. 
External. — Amyl nitrite has no irritating or destructive quali- 
ties, but it causes loss of functional power in tissues with which 
it is brought into contact. When externally applied, therefore, 



AMYL NITRITE. 365 

it temporarily diminishes the activity of the sensory nerves. 

Internal. — When it is taken into the system by inhalation, the 
usual mode of administration, its characteristic effects are pro- 
duced with extraordinary rapidity, and if the dose is small 
they are evanescent. 

Circulation. — Immediately on its inhalation there follow 
marked flushing of the face, pain, heat, and a sense of fullness 
in the head, giddiness, throbbing of the temporal and carotid 
arteries, and a rapid and tumultuous action of the heart. Some- 
times, it is stated, the cardiac disturbance is distinctly manifest 
before the other symptoms. While the area of redness usually 
corresponds with that involved in blushing, it may extend over 
the entire trunk, and the flushing is due to the dilatation of the 
peripheral blood-vessels, both arteries and veins. It is supposed 
that these vessels in the face and neck occupy a somewhat ex- 
ceptional position as regards their innervation and their sus- 
ceptibility to the action of drugs, and as the meningeal vessels 
are also concerned in the dilatation, the various symptoms men- 
tioned are readily accounted for. The vascular dilatation 
spreads from the parts originally affected over the entire body, 
although the vessels of the extremities are involved to a less 
extent than those of the abdominal region. It seems prob- 
able that depression of the vaso-constrictor centre is concerned 
to some extent in the general vascular dilatation, but this has 
never as yet been demonstrated, and is certainly not the main 
cause, since it has been shown positively that amyl nitrite pro- 
duces dilatation by acting on peripheral structures. The seat 
of action of the drug is held to be the unstriated muscle of the 
arteries and veins, and the depression of this tissue and of the 
nerve terminations is now generally considered as the essential 
cause of the dilatation. That there is, however, an early cen- 
tral action, which later is overshadowed by this peripheral in- 
fluence, it is thought may perhaps be indicated by the rapidity 
with which the flushing of the face comes on and disappears. 
In experiments upon animals it has been found that the vascular 
dilatation is followed by a marked decline in blood-pressure, and 



366 PHARMACOLOGY AND THERAPEUTICS. 

in this it is believed that the heart is not concerned. The great 
acceleration of the heart has been mentioned, and in conse- 
quence of this there may at first perhaps be even a rise of blood- 
pressure, the dilatation being more than overcome by the quick- 
ened beat; but as the dilatation extends throughout the body 
the relaxation, particularly in the splanchnic area, soon has the 
effect of producing a profound fall in the blood-pressure. It 
also causes a dicrotic pulse. The tachycardia is generally 
attributed to a depression of the inhibitory (vagus) centre in 
the medulla, though vasomotor paralysis would also produce a 
rapid pulse, and by some it is thought that there is present, in 
addition, a feeble direct action on the heart. Large doses of 
amyl nitrite slow and weaken the cardiac contractions and 
finally arrest them, owing to direct muscular depression; but 
this direct action on the heart muscle, it is found, is produced 
much less readily than that on arterial muscle. While the drug 
has such a marked influence in accelerating the beat, no per- 
ceptible alteration in the force of the latter is caused by it. 

Respiration. — The quickness of the action of amyl nitrite is 
due to the extraordinary rapidity with which it is absorbed, 
especially through the lungs, and its first effects resemble very 
closely an incipient asphyxia. Sometimes, as in the case of 
ether, chloroform and other similar agents, the breath is held 
in the beginning, in consequence of a reflex from the nasal 
mucous membrane. Under the stimulating effect of the drug 
upon the respiratory centre in the medulla the respiration • is 
quickened and deepened, but if the inhalation is maintained 
sufficiently long, this effect is replaced by a depressing one, 
and, in consequence, the respiratory movements are rendered 
more slow and shallow, death eventually occurring from 
asphyxia due to a complete paralysis of the centre. 

Blood. — The immediate cause of the asphyxia is the produc- 
tion of methaemoglobin, a compound which parts with its oxygen 
much less readily than oxyhemoglobin, but which is eventually 
broken up by the tissues. The nitrites, however, unlike most 
other agents which change haemoglobin into methaemoglobin, do 



AMYL NITRITE. 367 

not have the power of causing destruction of the red corpuscles ; 
so that the only action is interference with oxidation. This 
effect is seen in the change of the color of the blood to a dark 
chocolate in animals. In man very little of the methsemoglobin 
formation process usually occurs, and even after the inhalation 
of very large amounts of amyl nitrite such discoloration 
of the blood is said to be scarcely ever observed. 

Kidneys. — The only effect of the drug on the urinary secre- 
tion appears to be one dependent upon its action on the cir- 
culatory system. If, therefore, the renal arterioles are relatively 
more dilated than those of the general circulation, the flow of 
urine will be increased, while if the reverse of this condition 
is present, it will be diminished. Its diuretic influence is never 
very marked, and if large amounts are taken, so that the 
blood-pressure is reduced to a low point, complete anuria may 
result. Sometimes in animals there is persistent glycosuria, and 
it is thought that this may perhaps be due to the partial 
asphyxiation of the tissues resulting from the formation of 
methaemoglobin. Amyl nitrite when given either by the mouth 
or by subcutaneous injection acts much less quickly and power- 
fully than when absorbed by the lungs, and it is stated that 
when administered hypodermatically it generally gives rise 
to glycosuria and slight diuresis. 

Nervous System. — Amyl nitrite is not known to exert any 
influence on the higher cerebral centres. The spinal cord is 
not acted upon in mammals, but is depressed in the frog. Its 
effects on the vagus and respiratory centres in the medulla 
have been mentioned. While, as stated, action upon the vaso- 
motor centre has not been demonstrated, it seems probable that 
the drug does possess such action; which, however, must be 
quite insignificant when compared with its effects on the peri- 
pheral vaso-constrictor mechanism. It acts not only upon the 
muscular coats of the vessels, but also produces slow paralysis 
of muscle of all kinds with which it comes in contact. The 
pain and sense of fullness in the head, as well as the giddiness 
and other symptoms following immediately upon inhalation, 



368 PHARMACOLOGY AND THERAPEUTICS. 

result from the vascular dilatation, in which the cerebral circu- 
lation fully participates, and the headache may persist for a 
considerable time. If large quantities are inhaled, there may 
be unsteadiness of gait and some confusion and restlessness. 
The pupils are dilated and disturbances of vision are apt to 
occur. -Some individuals in looking at a dark object on a white 
background see it surrounded by a yellow circle, outside of 
which there is a blue circle. Convulsions are not infrequently 
observed in animals. They are probably of cerebral origin, 
and, if so, due to direct action upon the nerve cells, and not 
dependent on the circulatory changes. Some authorities, how- 
ever, believe them to be due to anaemia of the brain, while 
others regard them as probably secondary to the asphyxia. 

Therapeutics of Amyl Nitrite. 
Heart and Blood-vessels. — In attacks of angina pectoris amyl 
nitrite is of great service, provided the arterial tension is high. 
When the rise of blood-pressure is due to a nervous contracture 
of the vessels, it is certain to give relief. In many instances 
where valvular disease of the heart is present, as well as in 
those in which there is merely functional disorder, it acts most 
promptly and efficiently. The nitrites are regarded as the most 
powerful pressure depressants known, and the action of amyl 
nitrite in the dyspnoea of cases of cardiac disease may, it is 
thought, be due to its lowering the pressure in the systemic 
arteries and thus relieving the heart. Its beneficial effects would 
not therefore result from any direct action on the heart, but 
from its decreasing the resistance against which the systole 
is performed. Its physiological action in accelerating the pulse- 
rate has led to its recommendation in all forms of sudden heart- 
failure, even when such failure is dependent upon fatty degen- 
eration or other disease of the heart itself. It may be stated, 
however, that in very advanced degeneration of the cardiac 
muscle fibre it is distinctly contra-indicated, since, the blood- 
pressure already being low, any further reduction may induce 
syncope from cerebral anaemia, while the heart may be still fur- 



AMYL NITRITE. 369 

ther weakened by the lessening of its nutrition from lowered 
pressure in the coronary arteries. The use of the drug would 
also seem to be unsafe when advanced degeneration of the 
cerebral vessels exists. It may be employed in all cases in 
which, there being no contraindication to its use present, it is 
desired to reduce the arterial tension. In practice it is found 
that dyspnoeic attacks connected with heart failure from valvu- 
lar disease and other causes are not infrequently relieved by 
it. In spite of the fact that amyl nitrite, if used freely, is ca- 
pable of producing syncope by its depressing influence on the 
heart, it is claimed that in many cases of syncope and collapse, 
depending on a variety of conditions, recovery has attended 
its administration by inhalation. 

It has even been recommended and used in chloroform syn- 
cope, and a considerable number of instances have been re- 
corded in which the patients, it is asserted, were rescued by 
it from impending death. On the other hand, it is the opinion 
of some of the highest authorities on the action of drugs that 
these patients recovered in spite of and not in consequence 01 
its use. It would appear to be strongly contra-indicated, they 
state, in those cases in which it is true that the heart is de- 
pressed, but in which the arterial tension is practically zero; 
and its use is especially irrational if, as has been suggested, the 
failure of the respiration is partly due to anaemia of the central 
nervous system. The reasoning of those who advocate the ex- 
hibition of amyl nitrite is as follows : It is certain that chloro- 
form contracts, and that amyl nitrite dilates, the capillaries of 
the brain and of the skin of the face; under the former the 
patient grows pale, under the latter he is flushed. In experi- 
ments upon animals if the nitrite be used in excessive dose, 
cyanosis arises in consequence of venous engorgement. Experi- 
ments have also shown that if it is given in full doses to an 
animal already narcotized by chloroform, it deepens instead of 
relieving the narcotism, while if it be administered in moderate 
quantities, either by inhalation or hypodermatically, it revives 
the heart's action and removes the pallor caused by the chloro- 
25 



370 PHARMACOLOGY AND THERAPEUTICS. 

form. The salutary or pernicious effects of the nitrite therefore 
being due to the amount of it administered, they regard its 
beneficial action as happily illustrated in the cases referred to. 
In threatened death from chloroform the plan has been adopted 
by some of placing over the patient's face a little lint on which 
amyl nitrite is sprinkled, and at the same time carrying on 
artificial respiration. A small amount of the vapor may no 
doubt be of service in certain cases of syncope and cardiac 
failure where deep inhalations might perhaps be a source of 
danger. In heart-failure from fright, for instance, it has often 
proved of great value in single whiffs, but if it does not afford 
relief at once it is worse than useless to continue it. 

Aside from cardiac affections, it is especially indicated in 
various morbid conditions resulting from vaso-motor spasm, 
and may be employed in all cases in which dilatation of the 
capillaries is likely to prove of service. For relaxing general 
spasm and spasm of either vaso-motor muscular fibres or 
the voluntary or involuntary muscles it is a highly esteemed 
remedy. In tetanus and in strychnine poisoning it is worth 
trying and may prove of distinct value. It should be used 
between the spasms or else administered by subcutaneous in- 
jection, as the respiratory cramp interferes with its absorption 
by inhalation. Good results have been reported from its em- 
ployment in trismus nascentium. In hydrophobia, although 
having no effect in checking the progress of the disease, it 
may prove of service in alleviating suffering and in enabling 
the patient to take food and drink. In persistent hiccough the 
inhalation of amyl nitrite has been known to arrest the spasm 
of the diaphragm after various other measures had failed. 

Considerable attention has been paid to its use in the treat- 
ment of epilepsy. There can be no question of its utility in 
many cases in which the paroxysm is preceded by an aura 
giving the patient warning of its onset. By relieving the vaso- 
motor spasm of the cerebral vessels it often serves to prevent 
the occurrence of the fit if inhaled in time, and consequently 
epileptics who have such a warning of impending seizures 






AMYL NITRITE. 371 

should always be provided with a supply of the nitrite, which 
can be most conveniently used when put up in little glass cap- 
sules known as "pearls," each containing .30 gm. (5 1U), 
which can be readily crushed in the handkerchief. After the 
paroxym has commenced the remedy is hardly likely to be of 
much service, except in those cases which are apparently de- 
pendent on a vaso-motor spasm of the vessels supplying the 
motor areas, and if resorted to should be employed with cau- 
tion, because its early effects will be obscured by the patient's 
condition. In what is known as the status epilepticus, however, 
where there is a series of recurring paroxysms, it has some- 
times been found of great service in putting a stop to the con- 
vulsions. One of the uses of amyl nitrite is as a means of 
diagnosis between true petil mal and cases in which that affec- 
tion is simulated by attacks caused by temporary congestion 
of the nerve-centres. In the latter the nitrite, instead of 
alleviating the condition, intensifies the paroxysm. It should 
be mentioned that certain authorities regard this agent of little 
or no value in spasmodic seizures, such as epilepsy, and state 
that in some cases it even seems to increase the tendency to 
convulsions. Good results have been claimed by some from 
its use in the treatment of puerperal eclampsia, but it should 
never be employed in this disorder when the convulsions con- 
tinue after parturition or come on subsequently to the birth 
of the child, on account of the great danger of its inducing 
haemorrhage by relaxing the uterus. It is also stated to be 
useful for relieving after-pains, but its administration for this 
purpose is contra-indicated for the same reason. In any con- 
vulsive disorder in which the condition is regarded as attribu- 
table to a vaso-motor spasm of the vessels supplying the motor 
areas it would naturally be likely to prove beneficial. In many 
cases of hysterical convulsions, whatever may be the primary 
cause of the nervous trouble, such a state of vaso-motor spasm 
undoubtedly exists, if only a link in the pathological chain, and 
in practice it has not infrequently been found to arrest the 
paroxysms, while not controlling other symptoms. In infantile 



U 2 PHARMACOLOGY AND THERAPEUTICS. 

convulsions it has also sometimes proved of service. Amyl 
nitrite is antagonistic to ergot in its action. It may therefore 
be given to counteract the evil effects of this drug, and its 
inhalation has been known to promptly reduce hour-glass con- 
traction of the uterus caused by the latter. 

It may often be used with advantage in various painful affec- 
tions in which there is a spasmodic element, and among these 
may be mentioned spasmodic dysmenorrhcea, angiospastic hemi- 
crania, and chordee. In those cases of migraine in which there 
is local vasomotor spasm, causing contraction of the capillaries, 
it is a most valuable remedy; but if, instead of a pallid there 
is a flushed countenance, with conjunctival injection, it will 
only aggravate the patient's suffering. As to headache in gen- 
eral, it will sometimes relieve and sometimes increase the pain, 
its beneficial effect or the reverse depending largely on whether 
the arterioles are constricted or dilated. Neuralgia of the fifth 
nerve and other neuralgias are at times relieved and in some 
instances cured by it. If the pain is mitigated or removed by 
it, but subsequently returns, the inhalations should be repeated 
from time to time as required. In that distressing affection 
tinnitus aiirium, which is also often very obstinate, decided 
benefit has been derived from its use in a considerable propor- 
tion of cases. 

In its action of relieving spasm of the muscular system gen- 
erally, as well as of the arterioles, are included the bronchial 
tubes, and hence it has been found a valuable remedy for the 
symptom asthma. In the paroxysms of typical asthma it 
usually, though not always, affords immediate and complete 
relief. What interferes to a considerable extent with its use- 
fulness, however, is the fact that the patient rapidly becomes 
accustomed to its employment, and hence increasing doses are 
necessary when it has to be administered frequently in the 
same case, in order to overcome the diminution in the effects 
resulting from repetition. This naturally applies to other affec- 
tions also. Amyl nitrite may often be used with advantage in 
the treatment of catarrhal spasm or pseudo-croup of children 



AMYL NITRITE. 373 

and of the various forms of laryngismus ; and in some instances 
is of service in Cheyne-Stokes respiration. In whooping-cough 
it is of no value. While it was at one time thought by some 
that it allayed the violence of the cough and shortened the 
paroxysms, the remedy has now been practically abandoned in 
that disease. It is said to have sometimes proved efficacious in 
the vomiting of pregnancy, and there can be little question of 
its beneficial effect in many, though by no means all, cases of 
seasickness. In intermittent fever it will abort the cold stage 
of the paroxysm, but has no influence upon the ensuing hot 
stage. It would seem that the drug might be decidedly valu- 
able in the dangerous algid stage of pernicious malarial fever. 
It has been recommended as an injection, much diluted, in 
chronic cystitis, where the secretion is catarrhal and has a bad 
odor. Fetor from the putrefaction of- other secretions and ex- 
udations, and from gangrene, the decomposition of morbid 
growths, etc., it is said, may also be corrected by solutions of 
amyl nitrite. 

TOXICOLOGY. 

So far as known, only one death has occurred from the use of amyl 
nitrite (in this case a patient suffering from pulmonary tuberculosis 
took a large quantity by inhalation) ; but in a considerable number of 
instances very alarming symptoms have been caused by it, and several 
cases are on record in which very small, and even minute, doses pro- 
duced unconsciousness. 

Treatment. — In case of serious symptoms arising from its use vomit- 
ing may be caused, if necessary, by apomorphine or other emetics. Its 
effects should then be counteracted by the employment of artificial res- 
piration and by the subcutaneous injection of strychnine and digitalis, 
the latter of which has an antagonistic action on the circulatory system. 
Other measures recommended are the exhibition of ammonia by inhala- 
tion, by the mouth, or by intra-venous injection, and the hypodermatic 
use of atropine or ether. At the same time cold water or an ice bag 
may be applied to the head, and a sinapism to the epigastrium. A hot 
mustard foot-bath may also be given, the patient being kept in a re- 
cumbent position. 



374 PHARMACOLOGY AND THERAPEUTICS. 

NITROGLYCERIN. 

SPIRITUS GLYCERYLIS NITRATIS (Spiritus Glonoini, U. S. P., 
1890). — Spirit of Glyceryl Trinitrate. Spirit of Nitroglycerin. (Spirit 
of Glonoin.) Dose, 0.05 C.C.; 1 TT[. 

Action of Nitroglycerin. 
It is at first sweetish to the taste, but afterwards gives an 
impression of aromatic pungency. Its action is practically the 
same as that of amyl nitrite, but its effects on the system are 
produced with less rapidity and last considerably longer. The 
headache caused by it is frontal, and of great severity, and 
often persists for hours after the other effects have disap- 
peared. Nitroglycerin is a nitrate, and similarity of its action 
to that of amyl nitrite and other nitrites is due to the fact that 
it is readily converted into nitrites in the presence of alkalies, 
a change which has been demonstrated to take place in the 
blood. It is thought probable that the action of all the nitrite 
group is due to the effects of nitrous acid. There, appears to 
be a very great difference in the susceptibility of different in- 
dividuals to the influence of nitroglycerin. While in one person 
0.0013 gm. (-^L- grain) may give rise to its full physiological 
effects, it may take twenty-five times that amount to produce 
the same result in another. Very small doses have been known 
to cause unconsciousness and complete disappearance of the 
pulse at the wrist. After toxic quantities there is a marked fail- 
ure of cardiac action. A number of deaths have been reported 
from over-doses of the drug, and in these cases there were 
vomiting and purging, while the immediate cause of the fatal 
result seemed to be failure of the respiration. It may be men- 
tioned that, after gradually increasing the quantity, as much 
as 0.39 gm. (6 grains) of nitroglycerin for a dose has been 
given regularly, not only without any serious consequences, but 
with apparent advantage. 

Therapeutics of Nitroglycerin. 
Its most important use is for the relief of symptoms asso- 
ciated with the high tension pulse of chronic renal degeneration. 



NITROGLYCERIN. 375 

Here the dose should be rapidly increased until relief is ob- 
tained. In general, it is much relied upon in cases of habitual 
high pressure, especially of arterial sclerosis in which the in- 
creased peripheral resistance is developing, or has produced, in- 
creased cardiac power. It is also of service in many of the 
affections in which amyl nitrite is used, and has the advantage 
of being more lasting in its effects. Among these may be 
mentioned asthma, angina pectoris, cardiac failure, seasickness, 
reflex vomiting, gastralgia, hepatic colic, hiccough, laryngismus, 
neuralgia of the fifth nerve, migraine (when the face is not 
flushed from dilated vessels), neuralgic dysmenorrhea, epilepsy, 
and tetanus. In some cases of chorea it is also said to have 
been efficient. In angina pectoris (in which amyl nitrite is 
generally to be preferred if the utmost promptitude is required), 
it will naturally prove of the most benefit in cases characterized 
by high tension of the peripheral vessels. A very happy appli- 
cation of nitroglycerin is in the warding off of anticipated 
attacks of angina. A patient subject to such may take a suffi- 
cient dose of the remedy a few minutes before making any 
exertion which experience has shown is likely to bring on a 
paroxysm, or he may be able to prevent the attacks by using 
minute doses at frequent intervals during the entire day. In 
heart troubles, whether valvular disease is present or not, it 
often affords the most efficient relief, and in all the various 
forms of cardiac dyspnoea it is of the greatest possible service. 
It appears to do good by restoring or approximately restoring, 
at least for a time, the normal relationship between the force 
of the heart's action and the resistance of the vessels, and the 
pulmonary circulation itself is no doubt favorably affected by 
its action. Its beneficial effects are not so much due to any 
direct action on the heart as to its diminishing the resistance 
against which the systole is performed; so that the contraction 
of the ventricle is rendered more complete, and the output of 
the heart increased. It has been noted that the continuous want 
of breath met with in some cases of cardiac failure is less 



376 PHARMACOLOGY AND THERAPEUTICS. 

amenable to such relief than dyspncea which is more paroxysmal 
in character. Nitroglycerin may often be combined very ad- 
vantageously with digitalis in organic disease of the heart, in 
order to neutralize the marked vaso-constriction caused by that 
drug. Digitalis has unquestionably been used far too indis- 
criminately in cardiac affections; but it has been remarked by 
those who have had good opportunities for observation that 
during the past few years, in which the nitrites have been 
commonly used in this way, digitalis has been productive of 
much less harmful results than formerly. Nitroglycerin is, 
then, an efficient and generally safe remedy, and it can be given, 
in sufficient quantity to secure the desired action, for long 
periods without ill effects. In cases of valvular disease in which 
the cardiac muscle is incapable of being stimulated to increased 
force by digitalis (as in fatty degeneration), and in which that 
drug does harm instead of good, it may be used as a last resort, 
effecting relief if not contributing to a cure. 

In the treatment of anaemia, in its ordinary form and in the 
pernicious variety, it has proved a valuable agent. Here the 
assimilative processes are generally so imperfectly performed 
that the food taken cannot be utilized in blood-making, while 
the organs concerned in the latter may be in a pathological con- 
dition, or functionally torpid. To bring about a proper activity 
of the nutrition it is necessary to restore the organs of circula- 
tion and admit the fullest nutrient supply to all the tissues ; and 
this, it is believed, nitroglycerin is of great assistance in accom- 
plishing. It has been recommended in the algid stage of cholera 
and, injected subcutaneously, has been found of service in 
poisoning by illuminating gas. The severe headache which it is 
apt to produce is found in a considerable proportion of cases 
to disappear after repeated employment. 

SODIUM NITRITE. 
SODII NITRIS.— Sodium Nitrite. Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 



NITROGLYCERIN. 377 

Action of Sodium Nitrite. 

External. — Locally applied, sodium nitrite, like amyl nitrite- 
tends to destroy the functional activity of the tissues. 

Internal. — Under the effect of a moderate dose of sodium 
nitrite the heart's action is slightly quickened and the pulse 
tension falls. There may or may not be some feeling of full- 
ness in the head, but not often any throbbing, and there is gen- 
erally no flushing of the face. With larger doses the fall of 
tension is very marked and the same characteristic symptoms 
in general are produced as in the case of amyl nitrite. Some- 
times profuse perspiration and more or less cyanosis are seen, 
and faintness and nausea may occur. In those specially sus- 
ceptible to the influence of the drug partial unconsciousness and 
collapse may result. It appears to have a depressing action 
upon muscular tissue, and in the frog, contrary to the effect 
of amyl nitrite, the muscles are paralyzed before the spinal 
cord. It is both absorbed and eliminated more slowly than 
either amyl nitrite or nitroglycerin, and its effects on the system 
are very much more permanent than those of the former and 
considerably more lasting than those of the latter. One dis- 
advantage connected with its administration is the eructations 
to which it frequently gives rise, in consequence of the fact that 
part of its nitrous acid is liberated by the action of the gastric 
juice before absorption can take place. Some irritation of the 
gastro-intestinal mucous membrane also is liable to be caused 
by the nitric acid formed from it. The greater part of the 
nitrite which is absorbed is excreted as nitrate in the urine, but 
some of it may remain unoxidized. In experiments on small 
animals, such as cats and guinea-pigs, it has been found that 
lethal amounts of sodium nitrite produce general sedation, mus- 
cular paresis, slowing of the heart, fall of arterial tension, 
cyanosis, asphyxia and paralysis, while after death the heart 
and lungs are seen to be gorged with black or chocolate-colored 
blood. 



378 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Nitrite. 
The action of this agent, though apparently milder and less 
certain in effect, is analogous to that of amyl nitrite and 
nitroglycerin, and it may be employed in the various condi- 
tions in which these drugs are of service. As a mat- 
ter of fact, however, it is much more rarely used in med- 
ical practice than either of them. Wherever an immediate 
and powerful effect is desired they are both to be preferred to 
it, and while its effects may be more lasting, nitroglycerin is 
so extremely easy of administration that its repetition at suffi- 
ciently frequent intervals will prolong its influence to any re- 
quired extent. In some cases, however, it may be found to 
act more satisfactorily than nitroglycerin, and as it is much 
less likely to produce severe headache than the latter, it may 
be advantageously substituted for it in patients in whom the 
headache proves an objection. As sodium nitrite is liable to be 
decomposed by the gastric acids, it has been recommended that 
it should be given in an alkaline solution. 

SPIRIT OF NITROUS ETHER. 

SPIRITUS ^GTHERIS NITROSL— Spirit of Nitrous Ether. 
(Sweet Spirit of Nitre.) Dose, 2 c.c; 30 TTt- 

Action of Spirit of Nitrous Ether. 

External. — When applied to the cutaneous surface it quickly 
evaporates, giving rise to a slightly anaesthetic effect. 

Internal. — Spirit of nitrous ether, although it has long been 
extremely popular as a diaphoretic and a diuretic, has been 
found to have in reality little action upon either the skin or 
the kidneys, while it is inefficient in the reduction of tempera- 
ture. Its principal value is as a carminative and diffusible 
stimulant. It also has some antispasmodic influence, and acts 
as a mild sedative to the nervous and circulatory systems. Its 
physiological action as a nitrite is but feeble as compared with 
that of amyl nitrite, sodium nitrite, or nitroglycerin, its effects 
in this respect being overcome or modified by the alcohol enter- 



ERYTHROL TETRANITRATE. 379 

ing into its composition. In the case of a child of three years 
who died from taking 120 c.c. (4 ounces) of the spirit, the 
symptoms were those of alcoholic poisoning, with the addition 
of vomiting and purging. It should not be kept too long, as it 
is liable to turn acid after a time. 

Therapeutics of Spirit of Nitrous Ether. 
This time-honored remedy, so long and universally given as 
a diuretic, diaphoretic and antipyretic, no longer enjoys the 
vogue that it formerly held. It has, however, a limited sphere 
of usefulness. It may be given with good effect to children, 
particularly, suffering from feverishness with nervous symp- 
toms or mental excitement. Here it often has a pleasantly 
calmative influence, quieting the restlessness and promoting 
sleep. On account of its stimulating qualities it is especially 
serviceable in adynamic conditions. It is a grateful stomachic 
and carminative, and is useful, especially when associated with 
aromatic spirit of ammonia, in allaying nausea and causing the 
expulsion of flatus. In asthma and bronchitis it may be of 
assistance in relieving spasm and increasing the secretions of 
the mucous membrane, and it is frequently employed as a con- 
stituent in expectorant mixtures. It is also used to some ex- 
tent in combination with diuretics. Externally, it sometimes 
proves a soothing application to the forehead in neuralgic head- 
ache. 

ERYTHROL TETRANITRATE. 

ERYTHROL NITRAS.— Erythrol Nitrate, not official. (Erythrol 
Tetranitrate. Tetranitrole.) Dose, .03 to .06 gm.; y 2 to 1 gr. 

Action of Erythrol Tetranitrate. 
Like nitroglycerin, this is a dangerous explosive, and at 
least one fatal accident has occurred from its trituration in a 
mortar (with glucose). It has the same general action as the 
nitrites, causing dilatation of the vessels and a marked fall in 
blood-pressure, together with the formation of methsemoglobin. 
In the case of this drug and mannitol hexanitrate the charac- 






380 PHARMACOLOGY AND THERAPEUTICS. 

teristic effects on the system are produced more slowly and 
gradually, and last for a longer time, than under the influence 
of any others of the group. Its alcoholic solution is explosive, 
and it is therefore recommended that it should always be used 
in tablet form. 

. Therapeutics of Erythrol Tetranitrate. 
It is highly recommended in the treatment of angina pectoris, 
although, like other members of the nitrite series, it sometimes 
fails to give relief. It is often of special value, however, in 
warding off attacks of angina, for, while its influence is not 
exerted for half an hour or longer after ingestion, it is capa- 
ble of preventing the attacks for four or five hours. Some 
authorities, indeed, advise that the remedy should be used for 
this purpose solely; but this is a great mistake, as it has proved 
of very marked service in other conditions also. It is considered 
by many to be the best of the series for the relief of some of 
the symptoms of Bright's disease, and in cardiac affections, 
whether associated with renal trouble or not, it can often be 
relied upon with great confidence. This drug, it can scarcely 
be doubted, has not as yet been as generally employed as its 
merits deserve, and there can be little question that for con- 
stant use erythrol tetranitrate, properly administered; is superior 
to the more evanescent nitroglycerin and the somewhat uncer- 
tain sodium nitrite. It has been recently recommended in lead- 
poisoning with high arterial tension. 

2. Vaso-constrictors. 

SUPRARENAL GLAND. 

GLANDULE SUPRARENALES SICOE.— Desiccated Suprarenal 
Glands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Suprarenal Gland is a vaso-constrictor of the first importance, 
but will be considered in association with the other Organic 
Extracts, in Division XIII. 



BARIUM SALTS. 38 I 

BARIUM SALTS. 

Unofficial Preparations. 

1. Barii Dioxidum (U. S. P., 1890).— Barium Dioxide. 
(Barium Peroxide.) 

2. Barii Sulphidum. — Barium Sulphide. 

3. Barii Chloridum.— Barium Chloride. Dose, .006 to .03 
gin.; tV to y 2 gr- 

Action of Barium Salts. 
By its local action in the alimentary canal barium causes 
gastro-enteritis and some degree of corrosion. It is absorbed 
to a considerable extent, and the most conspicuous of its sys- 
temic effects are on the circulation. Barium chloride causes 
the cardiac contractions to become slower and more forcible, 
acting like digitalis. The blood-vessels are constricted, and 
the blood pressure rises. The increased tension caused by it 
may be due in part to the action on the heart, but is chiefly 
attributable to a very marked contraction of the muscular walls 
of the vessels. The plain muscular fibres of the intestine may 
be excited, and the peristalsis is increased. In these respects 
it resembles ergot, as well as digitalis. It acts like veratrine 
when applied locally to voluntary muscles, prolonging the con- 
traction; but this effect is done away with by the application 
of potassium salts. In warm-blooded animals barium salts, 
injected intravenously, by stimulating the spinal cord and 
medulla oblongata, induce violent tonic and clonic spasms. By 
sufficient quantities the central nervous system is finally para- 
lyzed. Barium is excreted in the urine and probably in the 
faeces. When given in very dilute solutions the amount absorbed 
is small, and it is then deposited in the bones. 

Therapeutics of Barium Salts. 

These are not often given, but the chloride has been used 

for mitral insufficiency accompanied by irregularity of the heart, 

for haemorrhage, and as a stimulant in atony of the bladder or 

intestine. Formerly it was given in nervous diseases. The 



382 PHARMACOLOGY AND THERAPEUTICS. 

waters of Llangammarch wells contain .40 gm. (6.7 gr.) to 
4545 c.c. (Imperial gallon) of barium chloride, and have been 
used in cardiac cases. The sulphide has been used as a de- 
pilatory. 

TOXICOLOGY. 

Symptoms. — Poisonous doses cause salivation, thirst, vomiting, purg- 
ing, difficulty of breathing, a slow pulse, and, from the action on the 
spinal cord, paralysis of the limbs. The heart is arrested in systole. 

Treatment. — Poisoning should be treated by non-irritant emetics and 
draughts of weak solution of sodium or magnesium sulphate, followed 
by albuminous drinks, and diffusible stimulants. 

TANNIC ACID. 

QUERCUS.— White Oak. Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Quercus. — Fluidextract of Quercus. Dose, 1 
c.c; 15 TTL- 

GALLA. — Nutgall. Dose, 0.500 gm. (500 milligm.) ; iy 2 gr. 

Preparations. 

1. Tinctura Gallae. — Tincture of Nutgall. Dose, 4 c.c; 1 
fl. dr. 

2. Unguentum Gallae. — Nutgall Ointment. 

ACIDUM TANNICUM.— Tannic Acid. (Tannin.) Dose, 0.500 
gm. (500 milligm.) ; 7y 2 gr. 

Preparations. 

1. Collodium Stypticum. — Styptic Collodion. 

2. Glyceritum Acidi Tannici. — Glycerite of Tannic Acid. 
Dose, 2 c.c; 30 irt. 

3. Unguentum Acidi Tannici. — Ointment of Tannic Acid. 

4. Trochisci Acidi Tannici. — Troches of Tannic Acid. 

Unofficial Preparations. 

Iodo-tanninum. — Iodo-tannin. 

Tannalbinum. — Tannalbin. Dose, .30 gm.; 5 gr. 

Tannigenum.— Tannigen. Dose, .30 to 2 gm.; 5 to 30 gr. 



TAXXIC ACID. 383 

Action of Tannic Acid. 

External. — Locally, tannic acid is an astringent and haemo- 
static, and its characteristic effect is the precipitation of albu- 
mins and other proteids, as well as gelatin and many alkaloids 
and glucosides. The precipitate thus formed is dense and re- 
sists putrefaction. This action occurs when the acid is applied 
to animal tissue, as in the tanning of leather, and the result is 
that the hide becomes harder, tougher, and somewhat shrunken, 
but retains its flexibility. Tannic acid is very slightly irritant, 
but this effect is more than counterbalanced by its astringent 
action. It apparently has no action on the unbroken skin, but 
on mucous membrane it has the effect of causing more or less 
coagulation in the cells, by direct action on the cells themselves; 
precipitating the albumin of the secretions (which it dimin- 
ishes), and forming a layer of albumin tannate which is pro- 
tective and antiseptic. Applied to a bleeding surface, it thus 
has a haemostatic action, coagulating the effused blood and 
plugging the vessels with clots, and still further tending to 
check haemorrhage by the constriction of the vessels caused by 
the contraction of the coagulum formed within the tissues. 

Internal. — Its taste is bitter, and in the mouth it produces a 
feeling of dryness, stiffness, and puckering. Very soon the 
sense of taste is partially lost, and the movements of the tongue 
are somewhat interfered with in consequence of the coagulation 
of the superficial layers of proteids both within and without 
the epithelium. This causes a roughness of the surface of the 
mucous membrane, so that the tongue cannot glide over it easily, 
as in the normal condition. In the throat the same feeling of 
astringency is experiencecd. Nausea and vomiting may some- 
times be caused by the drug, but this is not very often the case. 
In the intestines it diminishes the mucous and other glandular 
secretions, so that constipation results, and the faeces become 
dry, hard and scanty. The increased consistency of the stools 
is thought to be due to the layer of coagulated proteid acting 
as a protective to the bowel, lessening its irritability, and thus 
retarding its movements; so that there is longer time for the 



384 PHARMACOLOGY AND THERAPEUTICS. 

absorption of the fluid part of its contents. In the stomach 
tannic acid is found to combine with and precipitate any pro- 
teid substance with which it comes in contact, but, as digestion 
proceeds, such combination is broken up, the peptones not com- 
bining with this agent in acid solution ; and the astringent action 
is therefore exercised on the walls of the stomach and intes- 
tines. When given in large amount, however, it sometimes 
causes gastro-intestinal irritation and diarrhoea. Only about 
one per cent, of the tannic acid swallowed reappears in the ex- 
cretions, either as tannic or gallic acid; the rest would seem to 
undergo complete oxidation in the tissues. A small proportion 
is occasionally eliminated by the bowel unchanged, but the 
greater part is converted into gallic acid, some of which often 
passes out both in the stools and the urine. No evidence of 
any weight has been educed that tannic acid exerts any in- 
fluence after it has been absorbed. It does not exist in the 
tissues as such, but only in the form of traces of sodium 
gallate or tannate, too small to have any astringent effect; and 
it would appear, therefore, that its action is in fact limited to 
the point of application. As to its effects on blood-vessels, the 
most recent experiments show that solutions of less strength 
than y 2 per cent, cause constriction of the mesenteric vessels 
of the frog or rabbit when applied directly, while more con- 
centrated solutions occasion transient constriction, followed by 
dilatation. When it is injected intravenously, the precipitate 
produced is found to lead to the formation of emboli. 

Tannic acid is the chief principle of all the vegetable astring- 
ents. The tannic acid present is not always the same chemical 
body, but the various acids, such as catechutannic, kinotannic, 
etc., all have in common the power of precipitating albumins 
and other properties characteristic of pure tannin. The dif- 
ferences in the intensity of their effects is explained by the facts 
that some are more energetic precipitators of albumin than 
others, and that many of the drugs contain gum, resin and 
other matters which affect the solubility of the tannins. 



TANNIC ACID. 385 

Therapeutics of Tannic Acid. 

External. — Tannic acid is a very useful remedy, and its appli- 
cations are quite extensive both in surgery and medicine. It is 
employed to control bleeding in various parts of the body, and 
it may, if practicable, be dusted on the part, or be applied in 
the form of the glycerite or of styptic collodion. The latter 
is of special service in uniting incised wounds and protecting 
lacerated wounds. When applied on wounded or abraded sur- 
faces it checks the oozing and forms a firm coating in which 
the coagulated blood and secretions participate, and which ex- 
cludes the air from the part. In order to produce special effects 
on the diseased surface various agents, such as phenol, io- 
dine, or morphine, may be incorporated in the preparation, 
as desired, and carbolized styptic colloid, in which advantage is 
taken of the antiseptic and styptic properties of carbolic acid, 
is a very efficient haemostatic. It is prepared by adding ten 
per cent, of phenol to the official styptic collodion. 

Aside from its astringent and haemostatic effects, tannin is of 
value locally for removing fetor and for preventing or checking 
putrefactive changes in the tissues. Among the conditions in 
which its application in various forms is useful may be men- 
tioned aphthous ulceration of the mouth, spongy gums, mer- 
curial salivation, relaxation of the uvula, pharyngitis, nasal 
catarrh, otorrhoea, laryngitis, chronic inflammations of the 
conjunctiva, leucorrhcea, urethritis, cystitis, haemorrhoids, 
burns, chilblains, ulcers and other sores, and moist cutaneous 
eruptions. For local use the glycerite is probably the most 
generally satisfactory preparation of tannic acid, and the 
official strength may be readily altered to suit special condi- 
tions. A very concentrated solution, two parts of glycerin to 
one of tannin, may be made by the aid of moderate heat. 
This will be found very useful to prevent sore nipples if applied 
daily during the later months of pregnancy. The glycerite, in 
the strength of one part to eight of water, makes an excellent 
gargle. For pharyngitis and tonsillitis the troches are con- 
venient, and a spray (1 to 2 in 100 of water) or an insufflation 
26 



386 PHARMACOLOGY AND THERAPEUTICS. 

of tannic acid and starch may be used for the larynx, as well 
as the fauces. A powder made with one part of tannin to 30 
parts of orris — or marshmallow — root has been employed as a 
snuff to arrest acute coryza in its forming stage, and an oint- 
ment containing .06 gm. (1 gr.) of tannin and 8 gm. (2 dr.) of 
simple ointment has been applied to the nostrils, on a roll of 
soft linen or paper, for the same purpose in infants. In chronic 
nasal catarrh powdered tannin is sometimes used by insufflation, 
and in the treatment of nasal polypi a 10 per cent, solution in 
water has been employed. In ozaena and other affections at- 
tended with fetor tannin-wool (made by soaking cotton-wool in 
water, at 6o° C. ; 140 F., saturated with tannic acid, and 
drying the wool), has been found of service. The ointment 
of nutgall and opium (1 to 14 of nutgall ointment) is a favorite 
application for piles. In affections of the rectum tannic acid 
is recommended in the form of a suppository containing .20 gm. 
(3 &**•)> an d in those of the uterus in the form of a pencil 
about an inch in length, made with 4 parts of the acid to 1 of 
tragacanth. The glycerite, as well as iodoform-tannin, is re- 
garded as an excellent application for catarrhal inflammation 
of the cervix uteri, and even in cancer of the uterus is efficient 
in moderating the discharge and allaying odor. The benefit 
from it may be increased by combining with it the glycerite 
of phenol. Solutions (1 to 50) in water may be injected 
into the bladder for cystitis and into the urethra in the treat- 
ment of subacute gonorrhoea and gleet. Gonorrhoea has also 
been treated by filling the urethra once or twice daily with 
a powder consisting of equal parts of tannic acid, iodoform 
and thalline sulphate, introduced through a metal tube. In 
women a watery solution may be used as a vaginal injection, 
or the vagina may be packed with gauze covered with tannin. 
The decoction of oak bark, employed as a high rectal injection, 
destroys the thread-worm. A preparation of nutgall dissolved 
in glycerin was formerly used as an injection into hernial sacs 
(Heaton's method). The temporary results were excellent, but 
sooner or later failures occurred in a large percentage of cases. 



TANNIC ACID. 387 

A solution of tannic acid in tincture of benzoin (1 to 4) is said 
to tend to repress the development of the pustules of small-pox. 
A tannic acid lotion or ointment is sometimes of service in 
such skin affections as herpes, intertrigo, and weeping eczema, 
checking the discharge and allaying itching and irritation. 
Made into a pomade, it has been found of benefit in dandruff, 
and it is also useful in alopecia circumscripta. Introduced into 
a carious cavity, it not infrequently relieves toothache. A con- 
centrated solution is an excellent palliative remedy in ingrown 
toe-nail, especially when there are fungous growths, and is 
useful also for hardening tender feet. Ulcers of the rectum and 
anus and fissures of the anus are sometimes effectively treated 
by the application of the powder of tannin, tannin and iodoform, 
or iodo-tannin (solution of iodine in tannic acid). 

In acute dysentery good results have been obtained by the 
use of hot enemata consisting of a 4 per cent, solution of boric 
acid in which 0.60 gm. (10 gr.) of tannin is dissolved, with the 
addition of a few drops of laudanum. In the early stage of 
cholera, also, tannic acid enemata, carried beyond the ileo-csecal 
valve, have proved of service; the injections being composed 
of 6 to 20 gm. (i T / 2 to 5 dr.) of tannic acid dissolved in 2 litres 
(4 pints) of water, with the addition of 2 c.c. (30 Til) f 
laudanum and 45 gm. (iy 2 oz.) of powdered gum arabic. 

Internal. — As an internal remedy pure tannic acid is of little 
value. It is often prescribed in internal haemorrhages such as 
haemoptysis, metrorrhagia and haematuria, but it is doubtful 
whether, except in those of the gastro-intestinal tract, where, 
if given in sufficient quantity, there may be some opportunity for 
it to exert its local action, it really does any good in these con- 
ditions. Even for haemorrhage from the stomach or intestine 
other remedies are to be preferred. If employed in haemop- 
tysis, an atomized solution will afford the best chance of suc- 
cess. In excessive sweating, bronchorrhoea and leucorrhcea its 
internal administration has no effect in diminishing the dis- 
charge. In certain forms of diarrhoea its astringent action is 
of considerable value, and it may prove useful in checking the 



388 PHARMACOLOGY AND THERAPEUTICS. 

looseness of the bowels sometimes caused by such remedies as 
codliver oil. In these cases, however, the pure drug is seldom 
used, as it is liable to derange the stomach and to form com- 
pounds with the albumins before it reaches the intestine, and 
such agents as kino, gambir, and krameria, which owe their 
astringent qualities to tannic acid, are generally selected in 
the treatment. Remedies of this kind, whose activity depends 
on their containing tannic acid, differ from the pure drug in 
that the acid is only slowly dissolved out from the colloid mass, 
and therefore acts less on the stomach and affects a greater 
length of intestine. In chronic albuminuria the acid, in various 
forms, has been recommended for the purpose of checking the 
drain of albumin from the blood; but opinion is very divided 
as regards its efficacy, and it would seem altogether probable 
that it has no effect either in lessening the albumin in the urine 
or preventing its increase. As a temporary expedient in cases of 
poisoning with metallic compounds, such as tartar emetic, and 
with alkaloids, the exhibition of tannic acid may serve a useful 
purpose ; but it should always be followed by the prompt empty- 
ing of the stomach, as otherwise the tannate formed becomes 
gradually dissolved in the fluids of the alimentary canal. Cer- 
tain individuals, it has been found, are peculiarly susceptible 
to the action of tannic acid, which in such cases produces local 
irritation, and even inflammation, wherever it is applied. This 
remedy should never be used hypodermatically. 

Tannalbin (not official) is a tannin albuminate which has 
been subjected to a dry heat of 230°-248° F. (uo°-i20° C.) 
for several hours. It is a faintly yellow, tasteless powder con- 
taining about 50 per cent, of tannic acid. Laboratory experi- 
ments have shown that it is not easily decomposed by an arti- 
ficial gastric juice, but it is rapidly separated into its constituents 
in an alkaline medium or by an artificial solution of the pan- 
creatic ferments. This preparation accordingly passes through 
the stomach unchanged, and may not be broken up until it has 
got well down into the intestine. Tannalbin is preferably 
given in wafers at frequent intervals. It has been used with 



GALLIC ACID. 389 

considerable success in chronic diarrhoeas, even in cases in 
which intestinal ulceration was present. It has also been highly 
commended in gastric catarrh, and is said to have been found 
useful in diminishing the amount of albumin in chronic albumi- 
nuria. 

Tannigen (not official), the acetic acid ester of tannic acid, 
is prepared by the action of glacial acetic acid on tannic acid. It 
is a tasteless, odorless powder, insoluble in water, and is be- 
lieved to pass unchanged through the stomach and to be slowly 
decomposed in the intestines, thus exerting an astringent effect 
in them. This preparation also is usually prescribed in wafers. 
It has been used to a considerable extent in the diar- 
rhoeas of children, in whom its tastelessness renders its ad- 
ministration very advantageous, and it has proved especially 
serviceable in entero-colitis. In chronic intestinal troubles it 
is said to have been found less successful than in acute. Some 
observers, however, recommend it in chronic cases, and espe- 
cially in the diarrhoea of phthisis. It does not disturb the diges- 
tion, and has proved efficient in the treatment of gastric catarrh 
with excessive secretion of mucus. Locally applied, it appears 
to act well in catarrhal affections of the mucous membrane, and 
the powder may be used by insufflation in chronic rhinitis and 
laryngitis. 

GALLIC ACID. 

1. ACIDUM GALLICUM.— Gallic Acid. Dose, 1 gm.; 15 gr. 

2. PYROGALLOL.— Pyrogallol. 

Unofficial Preparations. 
Gallacetophenonum. — Gallacetophenone. 
Lenigallol.— Lenigallol. (Pyrogallol Triacetate.) 

Action of Gallic Acid. 

Gallic acid, given by the mouth, is absorbed, and, as has been 

stated, is excreted to some extent by the kidneys; but much 

of it disappears in the tissues, apparently by oxidation. It does 

not, like tannic acid, precipitate proteids, and has therefore no 



390 PHARMACOLOGY AND THERAPEUTICS. 

local styptic or astringent effect. It can be taken in very large 
quantity without producing any symptoms, its action being 
simply that of a weak organic acid. 

Therapeutics of Gallic Acid. 
It has been employed to a very considerable extent to pro- 
duce the supposed remote astringent effects of tannic acid, 
which, as has been seen, becomes largely converted into it in 
the body. Thus, it has been commonly given in the treatment 
of haemorrhage of all kinds and to some extent also in albumi- 
nuria. With our present knowledge, however, it seems prob- 
able that it has little, if any, therapeutic value. At the same 
time, it should be stated that it is still maintained by some clini- 
cians of repute that it should be prescribed when astringent 
effects on the tissues elsewhere than the intestinal canal are 
desired, and that in the treatment of renal haemorrhage it is more 
uniformly successful than any other remedy. It is also claimed 
that it is very serviceable in pyelitis, pyelo-nephritis, and catarrh 
of the bladder, as well as in chronic bronchial catarrh when 
the latter is the sequel of acute bronchitis or the result of the 
irritation extending from disease of the parenchyma of the 
lung, or when it is produced by mitral or tricuspid regurgita- 
tion. Others hold that, combined with opium, it is one of the 
best remedies in diabetes insipidus, and is even useful in dia- 
betes mellitus; but it is probably the fact that whatever benefit 
may be found in these cases is due entirely to the effect of the 
opium. It is also stated to have proved efficient in pyrosis, 
which is an annoying symptom of various dyspeptic conditions. 

Action of Pyrogallol. 
In its effects on the system, as well as chemically, pyrogallol 
is more nearly related to phenol than to gallic acid. When 
administered in large quantities to animals it gives rise to ner- 
vous symptoms analogous to those caused by carbolic acid, but 
in man, even in poisonous doses, it does not produce these ner- 
vous symptoms, or at all events to a very small extent; while 



GALLIC ACID. 39 1 

the other phenomena are similar to those observed in animals 
when smaller quantities are exhibited. The poison acts not so 
much directly on the central nervous system as upon the blood 
and, secondarily, upon the kidneys. The red corpuscles become 
shrunken and angular, and the greater part of their haemo- 
globin, escaping into the plasma, is converted into methsemo- 
globin, so that marked dyspnoea is likely to result. The color 
of the blood is changed to a brownish-red, in consequence of 
which the skin and mucous membranes become discolored, and 
if the toxic effect is not too acute, icterus follows, and both 
haemoglobin and methaemoglobin are excreted in the urine. It 
is not known whether the methaemoglobin is a direct result of 
the reduction of the haemoglobin by the pyrogallic acid, or 
whether this action is accompanied by a secondary oxidation. 
In the kidney the poison sets up an inflammatory process, which 
is indicated by the presence in the urine of albumin, epithelium, 
casts and the products of blood-decomposition, and which may 
lead to the production of uraemic convulsions. Pyrogallol is 
excreted in the urine partly as an ethereal combination with 
sulphuric acid and partly as unknown oxidized products, which 
give the secretion a dark brown or black color. When the re- 
sult is fatal, death appears to be due to the changes in the blood 
and nephritis resulting therefrom, rather than to any direct ef- 
fects of the drug on the central nervous system. In dogs poi- 
soned by it, it is said, hepatic lesions are produced identical with 
those caused by phosphorus. Poisoning, it has been shown by 
experiment, may readily take place by cutaneous absorption. 
The mineral acids act as antidotes to its effects. Pyrogallol 
precipitates albumin, and has a deep and strong local irritant 
action. In a 1 or 2 per cent, solution it is decidedly antiseptic. 
When it is applied in solution or ointment, it stains the skin, 
but not permanently; linen and clothing are, however, perma- 
nently darkened. To avoid the staining it has been proposed 
to dissolve the remedy in flexible collodion, 1 or 2 to 24. Its 
incautious application may cause inflammation of the skin, 
which may result in extensive ulceration and sloughing. A 



392 PHARMACOLOGY AND THERAPEUTICS. 

German dermatologist has recently stated that pyrogallol is 
a benzin with three hydroxyl groups, each of which may be 
replaced by acid radicals. Lenigallol, or pyrogallol triacetate, 
he describes as a mild preparation (ointments containing even 
50 per cent, causing no irritation when applied under a band- 
age), which is decomposed by the strongly alkaline perspira- 
tion, producing the characteristic darkening of pyrogallol, to- 
gether with its remedial action in cutaneous affections. 

Therapeutics of Pyrogallol. 
It is rarely given internally, and is almost exclusively used 
in the local treatment of various diseases of the skin. It should 
not be applied over too large a surface, on account of the 
danger of absorption, and fatal cases have occurred from the 
free use of an ointment on extensive cutaneous lesions. Con- 
sequently, chrysarobin, and also gallacetophenone, a derivative 
of pyrogallol, have been recommended and more or less ex- 
tensively employed as substitutes for it. If experience should 
confirm the efficacy of lenigallol, it might likewise be used with 
advantage in many instances in place of it. The curative effect 
of pyrogallol in skin affections is usually attributed to its irri- 
tant and antiseptic properties, but is referred by some to its 
reducing action. It undoubtedly has very considerable ger- 
micidal power. It may be employed either in the form of 
an ointment, or dissolved in flexible collodion or alcohol with 
the addition of a little glycerin. Jarisch's ointment (1 to 8) 
is entirely too strong for ordinary use; 1 or 2 parts (or even 
less) of pyrogallic acid to 48 of lard or lanolin will generally 
be found more satisfactory. Psoriasis, pityriasis versicolor, 
ringworm, ulcer, sloughing phagedena, and syphilitic lesions 
of the integument are among the affections in which it has 
proved of value. It has also sometimes been used with good 
effect in such serious diseases as lupus, leprosy and epithelioma. 
Before pyrogallol is employed vaseline should generally be thor- 
oughly applied, and wiped off, to remove scales and other 
morbid products. In some conditions it is recommended that 



GAMBIR. 393 

the remedy should be mixed with a powder, such as kaolin or 
starch, and dusted over the affected part. 

Occasionally it has been given internally, in frequently re- 
peated doses of .06 gm. (1 gr.), as a haemostatic in menor- 
rhagia, haemoptysis and haematemesis, but this practice has 
never received general favor, and more evidence is needed of 
its efficacy. 

GAMBIR. 

GAMBIR.— Gambir. (Replacing Catechu, U. S. P., 1890.) Dose, 1 
gm.; 15 gr. 

Preparations. 

1. Tinctura Gambir Composita. — Compound Tincture of 
Gambir. Dose, 4 c.c; 1 fl. dr. 

2. Trochisci Gambir. — Troches of Gambir. 

Action of Gambir. 
Gambir is a powerful astringent. It owes its astringent 
property to the tannic acid entering into its composition, and 
aside from this has no special action. 

Therapeutics of Gambir. 
The compound tincture is a favorite remedy in diarrhoea 
arising from various causes. If there is any source of irrita- 
tion in the intestinal tract, or if a considerable quantity of 
mucus in the discharges indicates a catarrhal condition of the 
bowel, its administration should be preceded by a purge, such 
as castor oil or magnesium sulphate. In the case of children 
it is often given in combination with paregoric and chalk mix- 
ture. It may be used to check internal haemorrhages, like 
haemoptysis and haematuria, and also in albuminuria, but is not 
reliable for these purposes. Locally it has a number of useful 
applications. In relaxation of the soft palate and uvula and 
in simple pharyngitis it may be employed in troches or in the 
form of a gargle. It is also used as a mouth-wash for spongy 
gums and as an ingredient of dentifrices. An infusion of gam- 
bir, thrown up the nostrils, will frequently arrest epistaxis. It 



394 PHARMACOLOGY AND THERAPEUTICS. 

is serviceable likewise in gonorrhoea and leucorrhcea and in 
relaxed conditions of the vagina. 

KRAMERIA. 
KRAMERIA. — Krameria. (Rhatany.) Dose, 1 gm.; 15 gr. 
Preparations. 

1. Extractum Krameriae. — Extract of Krameria. Dose, 0.500 
gm. (500 milligm.) ; 7y 2 gr- 

2. Fluidextractum Krameriae. — Fluidextract of Krameria. 
Dose, 1 c.c.; 15 rrt- 

3. Tinctura Krameriae. — Tincture of Krameria. Dose, 4 
c.c; 1 fl. dr. 

4. Trochisci Krameriae. — Troches of Krameria. 

5. Syrupus Krameriae. — Syrup of Krameria. Dose, 4 c.c; 
1 fl. dr. 

Action of Krameria. 
Krameria, like gambir, is a powerful astringent, and its 
action also is due to the tannic acid it contains. In small doses 
it is slightly tonic. 

Therapeutics of Krameria. 
It is used in the same class of cases as gambir, and, in addi- 
tion, sometimes as a stomachic and tonic. The fluidextract is 
especially valuable in diarrhoea, and may also be used in gastric 
and intestinal haemorrhage. In incontinence of urine from de- 
bility of the urinary organs it has been thought to be of benefit. 
Bleeding from the nose, the rectum, and other accessible parts 
may be stopped by locally applying the drug in powder or in 
infusion. The infusion (B. P., I to 20), as a gargle, and the 
troches are very efficient in relaxed conditions of the throat. 
The B. P. has a troche containing .06 gm. (1 gr.) of the 
extract and .003 gm. (^ gr.) of cocaine hydrochloride, with 
a fruit basis. Locally krameria is used with good effect 
in dysentery (by injection), and has enjoyed considerable repu- 
tation as a remedy for fissure of the anus. In the latter con- 






kino. 395 

dition it is believed, by constringing its walls, to prevent the 
formation in the rectum of large faecal masses, which would 
tend to stretch the fissure and render defecation more painful, 
and also to promote the healing of the lesion by diminishing the 
supply of blood to the part. In order to keep the bowels from 
becoming confined it is recommended that powdered belladonna 
root, in doses of .06 gm. (1 gr.), or less, be given at night. In 
fissured nipples a mixture of the extract with white of egg 
may be employed. In non-syphilitic ozsena an infusion of 
krameria, especially in association with chlorinated soda or cal- 
cium chloride, is sometimes of service as a nasal douche. Other 
conditions in which the drug may be used locally with advan- 
tage are sponginess of the gums, leucorrhcea, gonorrhoea and 
gleet. 

KINO. 

KINO.— Kino. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Preparation. 
Tinctura Kino. — Tincture of Kino. Dose, 4 c.c; 1 fl. dr. 

Action of Kino. 
Kino is another powerful astringent. Kinotannic acid has the 
same effects as tannic acid, and the action of the drug is almost 
identical with that of gambir. 

Therapeutics of Kino. 
The compound powder (B. P., kino, 75; opium, 5; cinnamon, 
20) is used especially for gastro-intestinal disorders attended 
with diarrhoea. In diarrhoea kino, gambir, krameria and others 
of the vegetable astringents act more efficiently than pure tannic 
acid, for the reason, as has been stated, that the latter is apt 
to form compounds with the albumins and exerts its astringent 
influence on a smaller portion of the intestinal tract. The 
tincture of kino is considered one of the most efficient means 
of combating the atonic diarrhoea resulting from the disuse of 
opium or morphine. Owing to the tendency of its gummy 



396 PHARMACOLOGY AND THERAPEUTICS. 

matter to coagulate, it is less eligible than gambir for use 
in connection with chalk mixture. It is often serviceable 
in relieving pyrosis. Locally kino has not, as a rule, been 
found as efficient as a haemostatic as tannic acid, but the in- 
fusion often acts promptly in checking epistaxis. The tincture 
is sometimes applied as a stimulant dressing to indolent ulcers, 
and is also employed in astringent gargles and in mixtures for 
injection in gonorrhoea. 

LOGWOOD. 
ILffiMATOXYLON.— Haematoxylon. (Logwood.) 

Preparation. 
Extractum Haematoxyli. — Extract of Haematoxylon. Dose, 
1 gm.; 15 gr. 

Action of Logwood. 
Haematoxylon is astringent and tonic. When chewed it 
colors the saliva a deep pink. It is unirritating, and does not 
cause constipation. It colors the urine and stools red, and also 
stains linen with which it comes in contact. It has been known, 
it is said, to give rise to phlebitis, and in very large doses is 
capable of producing fatal gastro-enteritis in animals. It is 
very feebly antiseptic. 

Therapeutics of Logwood. 
In the treatment of diarrhoea it may be combined with other 
astringents, with chalk, and with opium to check peristalsis. 
On account of its being pleasant to take and devoid of irritating 
qualities, it was formerly employed to a considerable extent in 
children's diarrhoeas; but its liability to stain the clothing ren- 
dered it objectionable, and of late it has been but little used, 
especially since the general adoption of dietetic and antiseptic 
methods in these affections. It is considered of decided value, 
however, in tuberculous diarrhoea and diarrhoeas of relaxation. 
The following formula, the proportions of which may be varied 
to suit individual cases, will often be found efficient, as well 



WITCHHAZEL. 397 

as agreeable to the patient: Extract of haematoxylon, 8 gm. 
(2 dr.) ; aromatic sulphuric acid, 12 c.c. (3 fl. dr.) ; paregoric, 
45 c.c. (i l / 2 fl. oz.) ; syrup of ginger, up to 120 c.c. (6 fl. oz.). 
Dose, a teaspoonful, properly diluted. Externally, logwood is 
said to display some antiseptic and healing qualities in the treat- 
ment of gangrenous and ill-conditioned sores, and a decoction 
made from it may be used as an astringent in leucorrhcea and 
bleeding piles. 

WITCHHAZEL. 

HAMAMELIDIS CORTEX.— Hamamelis Bark. Dose, 2 gm.; 30 
gr. 

HAMAMELIDIS FOLIA (Hamamelis, U. S. P., 1890).— Hamamelis 
Leaves. Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Hamamelidis Foliorum. — Fluidextract of 
Hamamelis Leaves. Dose, 2 C.C.; 30 TIT,. 

2. Aqua Hamamelidis. — Hamamelis Water. Dose, 8 c.c; 2 
fl. dr. 

Action of Witchhazel. 
Hamamelis, containing as it does, a considerable proportion 
of tannic acid, is astringent and haemostatic. Although extrava- 
gant claims as to the powers of this drug have been made from 
time to time, no experimentation has shown that it has any 
physiological action beyond that which might be expected from 
an agent rich in tannin. That it has a special influence over 
the venous circulation, analogous to that of aconite on the 
arterial system, as believed by some, has never been proved. 
In full doses it is said to sometimes produce severe throbbing 
pain in the head. 

Therapeutics of Witchhazel. 
Witchhazel is used internally to a very limited extent, not- 
withstanding the fact that certain authorities claim that its 
combined internal and external administration is of great effi- 
ciency in a variety of conditions, such as haemorrhoids (par- 



398 PHARMACOLOGY AND THERAPEUTICS. 

ticularly of the bleeding variety), varicose veins and ulcers, 
varicocele, venous congestions, threatening local inflammations, 
leucorrhoea, and subacute gonorrhoea. Internally, they would 
have us believe, it is of great service in haemorrhages from the 
nose, stomach, lungs, rectum, uterus and kidneys, in purpura 
hemorrhagica, in diarrhoea, enteritis and dysentery, in pyelitis 
and cystitis, in chronic bronchitis attended by copious dis- 
charge and the night-sweats of phthisis, in phlegmasia dolens, 
and in dysmenorrhoea and threatened abortion. When so much 
is claimed for a remedy one cannot but feel somewhat skeptical 
as to its real efficacy, and the mass of the medical profession 
is by no means as yet convinced that it is such a panacea. Ex- 
ternally, hamamelis is believed to have a sedative as well as 
astringent action upon congested or inflamed tissues, and an 
extract distilled from the fresh leaves (hazeline), especially, 
constitutes a useful and agreeable application in a considerable 
variety of conditions. Thus, it is used for sprains, bruises, and 
superficial inflammations, and, diluted, in inflammations of the 
gums, pharyngitis and nasal catarrh. Hamamelis is also em- 
ployed locally in the form of the fluidextract of the leaves 
and as an ointment (B. P., 1 to 10, made from the fluid- 
extract). The former, diluted, may be injected into the bladder 
in cases of catarrhal inflammation or haemorrhage, and is com- 
monly efficient in the treatment of capillary haemorrhage from 
wounds, epistaxis, spongy gums, bleeding sockets after the ex- 
traction of teeth, and bleeding piles. It is also used as a lotion 
for freckles, hyperidrosis, carbuncle and lupus erythematosus, 
and to relieve the pain and stiffness of chronic rheumatism. 
The ointment is recommended in burns, erysipelas, eczema, 
herpes, seborrhoea, acne and rosacea, intertrigo and sunburn, 
as well as in ulcers of the anus or rectum and fissures of the 
anus. A preparation of witchhazel in popular use is known 
as Pond's extract. It is said to be made by distilling the bark 
with very weak alcohol (6 per cent.), and no doubt owes its 
great pecuniary success more to the extensive manner in which 
it has been advertised and to the credulity of the public than 



GERANIUM. 399 

to any pronounced virtue that the remedy possesses. The new 
official Aqua Hamamelidis, made from hamamelis bark, ioo; 
water, 200; alcohol, 15, may be used for the same purposes as 
the fluidextract of the leaves. Taken altogether, hamamelis 
has not as yet been proved of such marked therapeutical value 
that its loss from the Pharmacopoeia would be very seriously 
missed. 

RHUS GLABRA. 

RHUS GLABRA.— Rhus Glabra. (Sumach.) Dose, 1 gin.; 15 gr. 

Preparation. 
Fluidextractum Rhois Glabrae. — Fluidextract of Rhus Glabra. 
Dose, 1 c.c; 15 in.. 

Action of Rhus Glabra. 
Sumach fruit is astringent and refrigerant. 

Therapeutics of Rhus Glabra. 

The fluidextract, when diluted, affords a simple and quite 
effective gargle for inflammation and ulceration of the throat. 
It is also of service in the treatment of aphthae and other forms 
of stomatitis, including that produced by mercury. The glandu- 
lar excrescences on the leaves are powerfully astringent, and a 
decoction made from the leaves or the inner bark of the root 
may be used for the same purposes, as well as for a wash and 
dressing for wounds and ulcers. An infusion of the strength 
of 30 gm. (1 oz.) to 500 c.c. (1 pint) is also sometimes em- 
ployed. Internally these preparations may occasionally be 
found of service in mild catarrhal affections of the stomach 
and bowels. 

GERANIUM. 

GERANIUM.— Geranium. (Cranesbill.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Geranii.— Fluidextract of Geranium. Dose, 
1 c.c; 15 m.. 



400 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Decoctum Geranii. — Decoction of Geranium. Dose, 30 to 60 
c.c; 1 to 2 fl. oz. 

Action of Geranium. 
Geranium is one of the best indigenous astringents, and, on 
account of the absence of unpleasant taste and irritating quali- 
ties, it is well adapted for use in the case of children and per- 
sons with very delicate stomachs. It has some tonic action, 
improving the appetite and digestion, and promoting nutrition. 

Therapeutics of Geranium. 
It is very useful in diarrhoea and dysentery, and also in 
the various haemorrhages. It is sometimes given to children 
boiled in milk. Among its other uses are the following: As 
an application to indolent ulcers, as an injection in gonorrhoea, 
gleet, leucorrhcea, fissure of the anus, etc., and as a gargle in 
relaxed or ulcerated conditions of the throat. In catarrhal 
inflammations the decoction is not infrequently more serviceable 
than a simple solution of tannic acid, which is thought to be 
probably due to the fact that there is present mucilaginous 
material, which acts as a demulcent. 

BLACKBERRY. 

RUBUS.— Rubus. (Blackberry.) Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Rubi. — Fluidextract of Rubus. Dose, 1 
c.c; 15 TTL. 

2. Syrupus Rubi. — Syrup of Rubus. Dose, 4 c.c; 1 fl. dr. 

Action of Blackberry. 
The preparations made from blackberry root are tonic and 
.slightly astringent. 

Therapeutics of Blackberry. 
These preparations are used for diarrhoea; blackberry brandy 
is a common domestic remedy. The most efficient one, how- 



RED GUM. 4OI 

ever, is the flmdextract. The fruit, either raw, cooked or pre- 
served, has no astringent quality, and is only likely to prove 
injurious, since the hard seeds serve to increase the intestinal 
irritation. 

RUMEX. 
RUMEX.— Rumex (U. S. P., 1890; no longer official). (Yellow 
Dock.) Dose, 1 to 4 gm.; 15 to 60 gr. 

Unofficial Preparations. 

1. Extractum Rumicis Fluidum (U. S. P., 1890). — Fluidex- 
tract of Rumex. Dose, 1 to 4 c.c; y 4 to 1 fl. dr. 

2. Decoctum Rumicis. — Decoction of Rumex. Dose, 60 c.c; 
2 fl. oz. 

Action of Rumex. 

Rumex is astringent, slightly tonic and alterative. The roots 
of some species unite a laxative with the tonic and astringent 
property, and their action has been compared to that of rhubarb. 
Taken very largely, the leaves are said to have produced poi- 
sonous effects. 

Therapeutics of Rumex. 

It has been used in syphilis, scorbutic disorders, and cuta- 
neous eruptions. Some species of rumex, given in hot decoc- 
tion, have been thought efficient in intermittent fevers, and 
others in chronic congestion of the liver with a gouty tendency. 
It is said to possess a selective action on the mucous membrane 
of the larynx and to afford relief in many cases of laryngeal 
irritation with catarrhal symptoms. The fresh leaf when 
bruised is a popular antidote to the eruption caused by the 
stinging nettle, and the decoction is sometimes applied externally 
in glandular swellings and various skin diseases. 

RED GUM. 

EUCALYPTI GUMML— Eucalyptus Gum (B. P., not official). 
(Red Gum.) Dose, .12 to .60 gm.; 2 to 10 gr. 

Action of Red Gum. 
Red gum is a useful astringent and has the advantage over 
27 



402 PHARMACOLOGY AND THERAPEUTICS. 

some others of its class that its effects upon mucous mem- 
branes are peculiarly permanent. It closely resembles kino, but 
does not equal that drug in astringency. 

Therapeutics of Red Gum. 
It is employed in the same kinds of cases as kino and other 
vegetable astringents. One of its chief uses is, in the form of 
lozenges, in relaxed and other conditions of the throat requiring 
an astringent. These lozenges usually contain .06 gm. (1 gr.), 
and are made with fruit paste. Internally it is given in 
decoction (1 to 40) and fluidextract (red gum, 7; water, 21; 
alcohol, 1) ; the dose of the one for diarrhoea being 8 to 15 c.c. 
(2 to 4 fl. dr.), and of the other, 2 to 4 c.c. { l / 2 to 1 fl. dr.). 
The decoction is frequently employed as a gargle, and the 
fluidextract is much esteemed as a basis for gargles. Injected 
into the nose the latter is often efficient in arresting epistaxis, 
and in the strength of 1 to 10 it may be injected into the rec- 
tum or vagina, or used as a mouth-wash. The fluidextract, 
unlike that of sumach, remains clear after being diluted with 
water. A suppository containing 30 gm. (5 gr.) is sometimes 
of service in haemorrhoids. 

COTO. 

Unofficial Preparations. 
Coto.— Coto Bark. Dose, .06 to .60 gm.; 1 to 10 gr. 
Cotoinum. — Cotoin. Dose, .06 to .12 gm.; 1 to 2 gr. 
Paracotoinum. — Paracotoin. Dose, .12 to .30 gm.; 2 to 5 gr. 

Action of Coto. 
Coto is not astringent, but, on account of the character of 
its therapeutic effects, may be given a place with this class of 
medicinal agents. It is irritant to the skin and to mucous mem- 
branes. The powder, rubbed on the integument, is said to pro- 
duce heat and redness, and in doses of 1 gm. (15 gr.) it has 
caused persistent burning pain in the stomach, followed by re- 
peated vomiting. In doses of .06 gm. (1 gr.) it is found to in- 



LEAD SALTS. 403 

crease the appetite and also to have a somewhat constipating 
effect. Cotoin appears to pass through the stomach unchanged, 
and is absorbed in the small intestine. It has been classed 
among antiseptics, but while it may have the power of retarding 
putrefaction outside the body, it has been demonstrated that it 
has no antiseptic action in the alimentary canal. When in- 
jected intravenously or perfused through the mesenteric blood- 
vessels in animals, it has the effect of causing marked dilata- 
tion of the intestinal vessels. This appears to be its principal 
physiological action, and to the improved nutrition and in- 
creased absorptive power which by this means it produces it is 
believed that the beneficial effects of the drug in intestinal dis- 
eases are to be attributed. After its internal administration it 
has been noted that the urine assumes a dark-red color on the 
addition of nitric acid. 

Therapeutics of Coto. 
Because coto produces absorption, coto bark and cotoin have 
established a reputation as remedies for diarrhcea, whether in- 
fantile, in phthisis or in typhoid fever. It also checks salivation 
and night-sweats. It is especially recommended for children 
suffering from marasmus with intestinal troubles. Asiatic 
cholera has been successfully treated by the subcutaneous in- 
jection of paracotoin in .20 gm. (3 gr.) doses, although this 
substance, which is a constituent of the paracoto bark, is much 
weaker than cotoin. It seems probable that whenever there is 
a tendency to acute inflammation of the gastro-intestinal tract 
this remedy should be used with considerable caution. A 10 
per cent, tincture of coto has been recommended by the British 
Pharmaceutical Conference; dose, .60 c.c. (10 "HI); every 2 
hours, with mucilage or syrup to suspend the large amount of 
resin which it contains. It should not be combined with Mistura 
Cretse. 

LEAD SALTS. 

1. PLUMBI OXIDUM.— Lead Oxide. (Litharge.) 



404 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Emplastrum Plumbi. — Lead Plaster. 

2. Emplastrum Adhaesivum. — Adhesive Plaster. 

3. Unguentum Diachylon. — Diachylon Ointment. 

2. PLUMBI ACETAS.— Lead Acetate. (Sugar of Lead.) Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Liquor Plumbi Subacetatis. — Solution of Lead Subacetate. 
(Goulard's Extract.) 

2. Liquor Plumbi Subacetatis Dilutus. — Diluted solution of 
Lead Subacetate. (Lead Water.) 

3. Ceratum Plumbi Subacetatis. — Cerate of Lead Subace- 
tate. (Goulard's Cerate.) 

3. PLUMBI NITRAS.— Lead Nitrate. 

4. PLUMBI IODIDUM.— Lead Iodide. 

Unofficial Preparations of Lead. 
Plumbi Carbonas. — Lead Carbonate (U. S. P., 1890). 

Unguentum Plumbi Carbonatis. — Ointment of Lead Carbon- 
ate (U. S. P., 1890). 

Unguentum Plumbi Iodidi. — Ointment of Lead Iodide (U. S. 
P., 1890). 

Action of Lead Salts. 
External. — Upon the unbroken skin the salts of lead have 
little or no action, though the integument is discolored by the 
use of some of them. Upon denuded surfaces they have a 
decided astringent effect, causing the contraction of the small 
blood-vessels, and in the case of sores and ulcers coagulating 
the albumin of the discharge and the protoplasm of the neigh- 
boring superficial cells; in consequence of which a protective 
coating is formed for the healthier structure beneath. In addi- 
tion, by reason of the local depletion resulting from vasocon- 
striction and also, it is thought, because of a depressant effect 
upon the sensory nerve-endings, they have a marked sedative 



LEAD SALTS. 405 

action. Any of these salts, if sufficiently concentrated and 
applied in sufficient amount, may be irritant and to a certain 
extent corrosive. 

Internal. Alimentary Canal. — From the mouth downward 
the lead salts have the same powerfully astringent effect upon 
the mucous membrane of the alimentary tract as upon the 
abraded skin. While they may occasion sufficient corrosion to 
be absorbed, this absorption never appears to be of sufficient 
extent to produce acute fatal poisoning from systemic effects. 
Almost the only result caused by ordinary doses is constipation. 
When given in large amounts they act as gastro-intestinal irri- 
tants, causing salivation, thirst, difficult of swallowing, abdomi- 
nal pain, vomiting and diarrhoea. There is a burning, sweet- 
ish taste in the mouth, and the vomited matter consists of 
whitish fluid containing curdy material, the color being due 
to the formation of lead chloride from a combination of 
the excessive lead with the hydrochloric acid of the gas- 
tric juice. In consequence of the astringent action of lead 
salts, the purging is not as marked as in the case of most 
irritant poisons, and sometimes there is constipation. If the 
bowels are moved, the passages are likely to be of a blackish 
hue from the presence of lead sulphide, and both the stools and 
the matters vomited may contain blood. 

Absorption and Excretion. — In whatever form or whatever 
doses lead is given, a small quantity is promptly absorbed, and 
while this may be incapable of producing any immediate symp- 
toms, its excretion is very slow, and consequently cumulative 
action is liable to result. Lead has been shown to be always 
absorbed in the form of soluble proteid combinations, and these 
may be formed from lead compounds which are perfectly in- 
soluble in water or acids. Even lead sulphate, one of the most 
insoluble of substances, will be absorbed in sufficient amount to 
produce poisoning, and hence, as previously mentioned (see 
P- 337) » sulphuric acid is of comparatively little value as a 
prophylactic in those exposed by their work to the action of 
lead. Lead is excreted in the secretion of the intestinal epi- 



406 PHARMACOLOGY AND THERAPEUTICS. 

thelium, the urine, bile, saliva and milk, and probably by the 
glands of the skin. Chronic lead-poisoning may sometimes be 
detected, it is said, by painting the integument with ammonium 
sulphide, which under these circumstances stains it black from 
the formation of lead sulphide. In the form of the sulphide 
the lead is sometimes deposited on the edge of the gums, giving 
the characteristic " lead line," which is also known as Burton's 
line. This is due to the presence of hydrogen sulphide produced 
by the action of bacteria, and is not often met with where the 
teeth are sound and kept clean. In the kidneys lead causes 
decided irritation during the process of excretion ; so that 
nephritis is found to be a frequent result of acute poisoning and 
an invariable one of chronic poisoning. A remarkable circum- 
stance in connection with lead-poisoning is the frequency of 
gout in its subjects. It is asserted by those who have had the 
largest experience with this disease that in one-fourth of the 
cases there is a history of saturnism; so that it would appear 
that the latter predisposes to gout, if it does not actually cause 
it. In districts where ordinary gout is rare, however, it is 
said that lead-poisoning seldom leads to it. The nephritis of 
chronic poisoning is sometimes, no doubt, in part secondary to 
this disease. It may also be in part secondary to the arterio- 
sclerosis resulting from fatty degeneration of the blood-vessels 
induced by the lead. Fatty degenerations are likewise found 
in the kidneys, liver, and other organs. The lead which is re- 
tained in the body is stored in the liver, kidneys, brain, bones 
and muscles, but chiefly in the liver. Only traces of it are 
found in the blood. 

Blood. — In chronic lead-poisoning there is always anaemia, 
which is due at first to the constriction of the peripheral vessels 
and subsequently to diminution of haemoglobin and the number 
of red corpuscles. The white corpuscles are generally, though 
not invariably, increased. Not infrequently jaundice results 
from the breaking up of red corpuscles and the liberation of 
large amounts of haemoglobin. 

Nervous System and Muscles. — In what is known as en- 



LEAD SALTS. 4O7 

cephalopathia saturnalis the disorders met with are for the most 
part of cerebral origin, although the lower divisions of the 
central nervous system are sometimes also involved. Upon the 
cortex, which is chiefly affected, there is produced an irritation, 
followed by paralysis, and the effects are both sensory and 
motor, the latter being the more pronounced. There are usually 
muscular contractures and then choreic movements. In some 
instances convulsions occur, and these are sometimes due to 
uraemia resulting from the nephritis, and sometimes to the lead 
itself. Later, paralysis succeeds the motor stimulation. In ad- 
dition, there is delirium, followed by depression and finally by 
coma, and the latter may also be uremic. In autopsies of some 
of the patients dying from lead-poisoning atrophy of parts of 
the cerebrum or haemorrhages, as well as disease of the blood- 
vessels, has been observed. In prolonged cases of lead-poison- 
ing degenerative changes may occur in the anterior columns of 
the spinal cord. On the motor system the effects produced are 
neuritis, paralysis and atrophy. Their usual seat is no doubt 
in the peripheral nerves and muscle cells, though the central 
nervous system would appear to be involved in some instances. 
In chronic poisoning in animals there is early muscular fatigue, 
which is followed by paralysis, and later by total atrophy. The 
heart is liable to be similarly affected, and even quite early 
in the poisoning; especially if the lead-salt is injected directly 
into the blood. The effect upon the motor peripheral nerves 
is believed to be very much like the direct muscular action. A 
common characteristic of lead-poisoning is the " drop wrist " 
or " painter's palsy," and this is probably attributable in part 
to paralysis of the extensor muscles and partly to the active 
contracture of the opposing flexor muscles. The most promi- 
nent of the peripheral effects is lead colic, a phenomenon which 
is due to violent contraction of the intestinal muscles, probably 
from stimulation of the nerve endings. As it is largely relieved 
by nitrites and other agents which dilate the blood-vessels, it 
is inferred that a primary vaso-constriction is one of its causes. 
As the spasm of the intestine forces the blood out of the 



408 PHARMACOLOGY AND THERAPEUTICS. 

splanchnic area, the general blood-pressure is raised and the 
pulse is slowed and rendered hard and tense. The pain, which 
is intense and grinding in character, . is located principally in 
the umbilical region, and the abdomen is retracted and hard. 
Paroxysms of the most acute agony are followed by intervals 
of comparative ease. The colic lasts for several days, or a 
week, and then disappears, but is apt to recur at intervals. 
Other affections, apparently, of the peripheral nerves are 
anaesthesia of various parts, lasting perhaps one or two weeks, 
and lead arthralgia, which consists of sharp lancinating or 
boring pains in the joints, bones, or the flexor muscles around 
the joints, and which generally appears and disappears quite 
suddenly. Neuralgias are occasionally observed, and these are 
probably sometimes due to peripheral neuritis and sometimes 
of central origin. One of the rarer phenomena of lead-poison- 
ing is amblyopia, in which the sight may be lost entirely or only 
rendered somewhat dim. This may be due to optic neuritis 
(which, unless arrested early, leads to atrophy of the nerve), 
to uraemia with an effusion into the optic sheath, or to albumi- 
nuric retinitis. 

Uterus. — Lead is very fatal to the life of the foetus, and under 
its influence abortion is liable to occur, or the child be still- 
born. It has been suggested that this result is probably due, 
in part at least, to the poor quality and diminished quantity of 
the blood supply. 

Therapeutics of Lead Salts. 
External. — Lead salts, in the form of lotions and ointments, 
are used, for both their sedative and astringent action, in a 
great variety of acute local inflammations. A very serviceable 
preparation is the glycerin of the subacetate of the B. P. (lead 
acetate, 10; lead oxide, 7; glycerin, 40; water, 24; boiled 
together), which should ordinarily be diluted fourfold with 
glycerin or milk. The Liquor Plumbi Subacetatis is sometimes 
successful in aborting a felon. For most other purposes it is 
apt to be too irritating, but the diluted solution, as well as the 



LEAD SALTS. 4O9 

cerate of lead subacetate (which should also usually be diluted), 
may be applied with advantage to contusions, acute eczema, 
erysipelas, and inflammations of various kinds. The solution 
may also be employed to allay itching in such affections as 
urticaria, paresthesia, etc. A lotion of lead and opium has 
long been a favorite application for relieving pain and inflam- 
mation. It may be prepared by mixing 30 gm. (5 gr.) of ex- 
tract of opium with 30 c.c. (1 fl. oz.) each of lead water and 
water, or may be made as follows: Solution of lead acetate, 15; 
tincture of opium, 30; distilled water, 120. Lead lotions, to 
which zinc sulphate is often added, are used for injections in 
gonorrhoea, gleet, vulvitis, leucorrhcea and otorrhcea. They 
were formerly also employed in conjunctivitis, but have been 
abandoned as applications for the eye; for if ulceration of the 
cornea be present, the white precipitate formed is liable to 
lead to permanent opacity. Y\ "hite-lead paint is a good applica- 
tion for burns and scalds where the skin is unbroken, and lead 
carbonate, mixed wtih olive oil and with the addition of a 
few drops of creosote, is recommended for erysipelas, burns, 
and for bruises, especially when the surface has a blue or dark 
discoloration. The following is an efficacious dusting-powder in 
acute eczema, herpes and seborrhcea: Lead carbonate, 8 gm. 
(2 dr.) ; zinc carbonate, 15 gm. (y 2 oz.) ; oil of eucalyptus, 
.30 c.c. (5 Tr L). Diachylon ointment mixed with an equal quan- 
tity of zinc oleate ointment and mercuric oleate ointment forms 
a transparent ointment, which will be found of service in a 
considerable number of conditions. Diachylon ointment is use- 
ful in seborrhcea, hyperidrosis, eczema, dermatitis, herpes zoster, 
and sycosis. Hebra*s diachylon ointment is made by melting 
equal, parts, by weight, of lead plaster and flaxseed oil, to 
which a proportion of balsam of Peru and a little oil of laven- 
der are sometimes added. Even in chronic diseases of the skin 
lead salts are often of service on account of their soothing and 
astringent effects. Lead plaster is excellent for preventing bed- 
sores and as a basis for other plasters, and is used by surgeons 
to protect parts of the body exposed to chafing by splints or 



410 PHARMACOLOGY AND THERAPEUTICS. 

other apparatus. Lead iodide ointment is a useful resolvent for 
glandular swellings, scrofulous tumors, goitre, chronic synovitis, 
etc., and, applied with steady friction, is said to be especially 
serviceable in acute mastitis with threatened suppuration. It 
may also be applied in acne and other cutaneous affections. A 
two per cent, solution of lead nitrate in glycerin is a very effi- 
cient application for fissured nipple, care being always taken 
to thoroughly remove all traces of it before the child is allowed 
to nurse. The nitrate, in very dilute solution, may be used 
also as a wash in leucorrhcea and to correct the fetid odor 
of discharges from ulcers, etc. Lead acetate, on account of its 
astringent action, is occasionally employed for mouth-washes 
and gargles, but other agents are ordinarily preferred for those 
purposes. In haemorrhoids, when there is much pain and a 
sense of burning heat at the anus, the addition of lead water 
to the ointments frequently used in these cases often affords 
marked relief. 

Internal. — Lead iodide, it is said, has been given in order to 
reduce enlargement of the spleen due to malaria. Practically, 
however, the only lead salt which is used for internal adminis- 
tration is the acetate, which is highly prized for its astringent 
and haemostatic effects. It has been largely employed for the 
purpose of arresting haemorrhage from the lungs, but is more 
especially adapted to the haematemesis accompanying gastric 
ulcer. In this affection it is also a very useful remedy in other 
ways; not only relieving pain, but modifying the ulcerated sur- 
face and checking inflammatory action as well. It is likewise of 
service in chronic catarrh of the stomach, with gastralgia and 
pyrosis. Theoretically it is incompatible with preparations of 
opium, but notwithstanding this, it is very often advantageously 
combined with them in painful affections of the stomach, as well 
as in various forms of diarrhoea. It is in the latter that lead ace- 
tate is most frequently used, and it is also relied upon for con- 
trolling intestinal haemorrhage, such as is liable to be met with 
in typhoid fever and tuberculosis. For these purposes a very 
satisfactory preparation is found in the Pilula Plumbi cum Opio 



LEAD SALTS. 4 I I 

of the B. P. (lead acetate, .20 gm. (3 gr.) ; opium, .06 gm. 
(1 gr.)). In choleraic diarrhoea, powders consisting of lead 
acetate, opium and camphor may be employed, or a mixture in 
which the acetate is associated with acetic acid and the tincture 
of deodorized opium. For the diarrhoea of typhoid, bismuth 
is usually preferable to lead acetate and opium. In rectal 
haemorrhage from various causes and in both acute and chronic 
dysentery the last-named remedies are of great service when 
employed locally, either by suppositories or enemata, and the 
following enema will be found useful in relieving the tenesmus 
of acute dysentery: lead acetate, .24 gm. (4 gr.) ; morphine 
acetate, .03 gm. ( J / 2 gr.) ; hot water, .30 c.c. (1 fl. oz.). Al- 
though now prescribed comparatively rarely in haemoptysis, 
lead acetate seems in some cases to act quite efficiently, and in 
this condition, as well as in caseous pneumonia, it has some- 
times been combined with digitalis and opium. Formerly the 
acetate was given in hypertrophy of the heart under the sup- 
position that it retarded the action of that organ, and also in 
internal aneurism. It is of some value in checking the night- 
sweats of pulmonary tuberculosis, and diminishes the copious 
secretion sometimes accompanying chronic bronchitis. It is 
open to the objection, however, of causing constipation. 

If lead acetate is administered for any length of time there 
is more or less risk of plumbism being induced, and some per- 
sons are peculiarly susceptible to the poisonous action of the 
drug. Its effects should therefore always be watched with 
care. Even the external application of lead solutions or oint- 
ments have occasionally been attended by colic and other un- 
toward symptoms. 

TOXICOLOGY. 

Acute Lead Poisoning. — The acetate is most frequently taken, and 
a very large quantity of it is required to produce a fatal effect. Owing 
to the fact that so much of the drug is generally vomited, cases 
of acute poisoning rarely terminate fatally. The gastro-intestinal symp- 
toms have already been described. They are followed by great weak- 
ness, coldness of the surface, and collapse. In some cases in which 



412 PHARMACOLOGY AND THERAPEUTICS. 

recovery took place the patients have been known to suffer from 
chronic lead poisoning, but it has been pointed out that apart from 
these nothing in the course of the acute poisoning suggests the absorp- 
tion of lead ; all the symptoms being obviously due to the local effects 
on the alimentary tract, and to the subsequent collapse. Post-mortem. 
— In the stomach and intestine such signs of irritant poisoning as red- 
ness, excoriation and softening are found. 

Treatment. — The stomach should be washed out or emetics {see p. 
J75) given. The precipitation of the lead should then be attempted 
by the administration of sodium or magnesium sulphate, or, if such 
sulphates are not procurable, by white of egg or milk, forming an insol- 
uble albuminate. If collapse is present, it should be combated by the 
administration of stimulants, by hypodermatic injection or by the mouth, 
and the external application of warmth. 

Chronic Lead Poisoning. — This is so common that the sources of 
accidental poisoning should be borne in mind. The most important 
are : soft water, carbonated waters and alcoholic drinks (beer) which 
have passed through lead pipes or been stored in receptacles lined with 
lead. The occupations of painters (colica pictonum), plumbers, type- 
setters, gold miners, white lead workers, potters, glaziers (Devonshire 
colic), because the men will not wash their hands before meals nor use 
ordinary care ; lead hair dyes and face powders, biting leaded white 
thread, eating certain canned fruits (lead solder), sheet-lead (tin-foil) 
about tobacco, filling holes in mill stones with lead, playing with tin (lead) 
soldiers by children, use of lead carbonate ointment on burns, lead bullets 
in flesh, white or red lead used for preparing rubber for vulcanizing, lead 
plates in dentistry, the use of lead chromate to color buns yellowish, 
have all been followed by chronic plumbism. Most of the symptoms 
and effects have been mentioned. Not only the extensors of the hand, 
but any muscle may be paralyzed (sometimes almost all the muscles 
of the body seem to be affected), and it is a clinical observation that 
such muscles are very refractory to electricity. The supinator longus, 
however, usually escapes, the reason for this apparently being that the 
supinator is not an extensor muscle. Lead is regarded as perhaps the 
best example of a poison which is comparatively free from danger in 
a single dose, however large, but which becomes fatal in the most min- 
ute doses, if these are taken for a sufficiently long time. 

Treatment. — The first thing to be done is the removal of the patient 
from the danger of further poisoning. In the general treatment reli- 
ance is placed upon potassium iodide, saline purgatives, diuretics, and 
the use of hot baths and massage to promote elimination, and the im- 



LEAD SALTS. 413 

provement, by appropriate measures, of the patient's nutrition and 
strength. Potassium iodide is universally employed, and appears to 
have a remedial effect, though the manner of its action is not clearly 
understood. It has generally been supposed to accelerate the elimina- 
tion of the poison by the kidneys, but recently it has been denied that 
it has any influence on the excretion either by the urine or by the intes- 
tine, by which most of the lead escapes from the body. Baths of sul- 
phurated potassa are quite efficient, especially if the patient is after- 
wards well soaped, then thoroughly rinsed off, and finally rubbed down 
with a rough towel. For the various effects of lead in the system spe- 
cial treatment is required. For the colic, opium or morphine is often 
necessary, alum, in .12 gm. (2 gr.) doses, is of great service, and sul- 
phuric acid is also useful {see p. 337). In a considerable number of cases 
of chronic lead poisoning it is found that cathartics fail to act unless 
morphine is given to overcome the intestinal inhibition produced by the 
irritation resulting from the lead. Opiates may also be required for 
the relief of the arthralgia. For the paralysis strychnine may be used, 
but the main reliance is to be placed on electrical stimulation and 
massage. If the muscles contract in response to the faradic current, 
this should be employed, but if they do not, the galvanic current. Ne- 
phritis and gout due to plumbism should be treated in the same way as 
if resulting from other causes, while the cerebral symptoms must be 
dealt with according to the special manifestations present. 

The following method may be employed to determine the presence 
of lead in the urine : Administer potassium iodide for four days, in the 
meanwhile collecting the urine. Evaporate the latter to 500 c.c. (1 pint), 
and filter. Pass hydrogen sulphide gas through the urine thus concen- 
trated, when a black precipitate will form if lead is present. Other 
substances give a black precipitate with hydrogen sulphide, but none 
such is likely to be present in the urine. A simple test for lead in the 
system is to paint a small area of skin with a six per cent, solution of 
sodium sulphite. If lead is present the painted area will darken after 
a few days. Patients using face enamels containing lead will find the 
skin blackened on taking baths in water containing hydrogen sulphide 
(Richfield Springs). 

Prophylaxis is of the greatest importance, and the public should be 
more generally instructed in regard to the insidious dangers of lead. 
Special precautions are required in lead works and paint factories, and 
in exposed trades. Dust should be avoided as much as possible, and 
where this is necessarily present, thorough ventilation of the rooms 
should be insisted upon. The necesssity of frequent bathing and of 



4I4 PHARMACOLOGY AND THERAPEUTICS. 

thorough washing before meals ought to be impressed upon the work- 
men. Food should not be permitted upon the premises, and the cloth- 
ing should be changed before leaving the works. The habitual employ- 
ment of milk in large quantity as a food has been recommended as of 
service. Sulphuric acid lemonade is quite generally made use of as a 
prophylactic, but little reliance can be placed upon it. Weak and anae- 
mic men ought not to be admitted as operatives in lead factories, and 
it is advisable that women should not be employed at all in them. 

SILVER SALTS. 

1. ARGENTI NITRAS.— Silver Nitrate. Dose, 0.010 gm. (10 mil- 
ligm.); y- gr. 

Preparations. 

1. Argenti Nitras Mitigatus (Argenti Nitras Dilutus, U. S. 
P., 1890). — Mitigated Silver Nitrate. (Mitigated Caustic.) 

2. Argenti Nitras Fusus. — Moulded Silver Nitrate. (Lunar 
Caustic.) 

2. ARGENTI OXIDUM.— Silver Oxide. Dose, 0.065 gm. (65 mil- 
ligm.) ; 1 gr. 

3. ARGENTI CYANIDUM.— Silver Cyanide. 

Unofficial Preparations of Silver. 

Argenti Iodidum (U. S. P., 1890).— Silver Iodide. Dose, 
0.015 to 0.06 gm.; y 4 to 1 gr. 

Argenti Citras.— Silver Citrate. (Itrol.) 

Argenti Fluoridum. — Silver Fluoride. 

Argenti et Sodii Hyposulphis. — Silver and Sodium Hyposul- 
phite. 

Argenti Lactas. — Silver Lactate. (Actol.) 

Argentum Colloidale.— Colloid Silver. Dose, .01 gm.; y 6 gr. 

Argentaminum. — Argentamine. 

Argoninum. — Argonin. (Silver Caseinate.) 

Argyrol.— Argyrol. (Silver Vitellin.) Dose, .30 to .60 gm.; 
5 to 10 gr. 

Larginum. — Largin. 

Protargol. — Protargol. 



SILVER SALTS. 4I 5 

Action of Silver Salts. 

External. — The local action of silver salts is in general simi- 
lar to that of lead salts — astringent and haemostatic — but they are 
more irritant and corrosive, especially the nitrate. The astring- 
ent effect produced by them is due to the formation of a protec- 
tive layer of albumin. While dilute solutions of the nitrate 
may possibly have some vaso-constrictor effect, if the salt is 
applied in sufficient strength to induce irritation, the blood-ves- 
sels will become dilated in consequence of this. Even in dilute 
solution silver is apt to be slightly irritating to the skin, pro- 
ducing redness and itching, while stronger solutions vesicate, 
and the solid nitrate causes an eschar. This is at first of a 
whitish color, but later turns black from the reduction of silver 
in light. The corrosive action of silver is less deep than that 
of some other metals, as its penetration is interfered with by 
the precipitation of silver albuminate. On abraded surfaces and 
mucous membranes dilute solutions act as astringents, but con- 
centrated ones are irritant and caustic. The silver salts possess 
very considerable antiseptic power, and, like other astringents, 
they tend to diminish suppuration by rendering the walls of 
the blood-vessels less permeable to inflammatory products. At 
the same time, they tend to prevent the further penetration of 
bacteria, and hinder their development by rendering the culture- 
ground unsuitable. Silver nitrate not only coagulates the pro- 
teids of the micro-organisms, but is also antiseptic from the 
specific effects of the metal, as is shown by the fact that silver 
albuminate is likewise an active disinfectant. The nitrate is 
employed by histologists for staining epithelium for micro- 
scopical purposes. 

Internal. — Unlike the lead salts, those of silver appear to 
have no astringent action when administered internally. In 
the stomach the soluble salts are probably converted into the 
chloride and albuminate, though the form in which the metal is 
absorbed is uncertain. As it is reduced to the inactive metallic 
state soon after entering the body, the use of silver does not 
lead to general poisoning. When it is given for prolonged 



41 6 PHARMACOLOGY AND THERAPEUTICS. 

periods, however, a slight proportion of the metal ingested is 
absorbed, this absorption being shown by a pigmentation of 
the skin and mucous membranes (argyria). Such discoloration 
is due to the deposit of minute granules which were formerly 
supposed to consist of metallic silver, but which are now 
thought to be an organic compound. They are found also in 
many internal organs, but are chiefly present in the connective 
tissues of the body. Argyria is sometimes observed in the 
workers in artificial pearls, who use silver as a pigment, and 
it may also result from the prolonged use of silver nitrate solu- 
tion as a local application to the eye, nose and throat. In man 
this pigmentation appears to be the only evidence of absorption. 
It is believed that most of the silver passes through the ali- 
mentary canal unabsorbed, and that none of the very small 
proportion which is taken up is eliminated; the entire amount 
remaining imbedded indefinitely in the tissues. In animals, how- 
ever, some is excreted by the epithelium of the alimentary canal. 
When silver is introduced into the circulation by subcutaneous 
or intravenous injection, its effects are found to differ from 
those of other metals in the predominance of nervous symp- 
toms. In mammals the action is chiefly upon the central ner- 
vous system, and especially the medulla oblongata, as shown by 
a rise of blood-pressure and slowing of the pulse, in consequence 
of increased activity of the vaso-motor and vagus centres. 
This stimulation is followed by paralysis ; the blood-pressure 
falling, and the respiration becoming slow and labored and then 
failing altogether. The heart is comparatively unaffected, and 
may continue to beat for some time after the respiration has 
ceased. There is also motor paralysis, beginning in the lower 
extremities. The secretion of bronchial mucus may be so 
markedly increased that it may lead to asphyxia, and this is 
thought to be due to injury to the epithelium. In cold-blooded 
animals violent convulsions, resembling those from strychnine 
and followed by paralysis, have been observed. Silver nitrate, 
in solid form or concentrated solution, is a gastro-intestinal irri- 
tant and corrosive. 



SILVER SALTS. 417 

Therapeutics of Silver. 

External. — Silver foil, or metallic silver in very thin sheets, 
is used as a surgical dressing for wounds and burns. It consti- 
tutes a protective covering which may be painlessly removed and 
renewed and which prevents or curtails suppuration. It is also 
said to reduce shock. Silver nitrate is in universal use as a caus- 
tic whenever a limited and clearly defined action is required, 
but is of no value for producing a deep or extensive escharotic 
effect. It is often applied to the bites of dogs and other ani- 
mals, but it is a dangerous caustic to employ in deep bites, for 
the pellicle of silver albuminate retains the poison in the wound. 
The solid nitrate is used also to destroy warts and other 
growths, to restrain the bleeding from leech-bites, and as an 
application for ulcers of the mouth, rectum and other parts, 
for venereal sores, and in catarrh of the cervix uteri. It is 
said to be of service when applied to the scrotum in acute 
epididymitis or orchitis, and in lymphangitis of the forearm from 
a poisoned wound of the finger, if applied along the course 
of the affected vessels. In erysipelas the disease may sometimes 
be arrested, it is claimed, by delimiting the affected area with 
silver nitrate. Boils or a stye on the eye have been aborted 
by its early use, and it has also been employed with good re- 
sults in eczema, lichen, herpes and other cutaneous affections 
when occurring in circumscribed patches. For tinea tricophy- 
tosis a solution in nitrous ether (2.60 gm. to 30 c.c. ; 40 gr. to 
1 fl. oz.) may be used. The mitigated caustic is a good appli- 
cation to granular lids, chancroids, small-pox vesicles (to pre- 
vent pitting), and in general to excite a healthy action of granu- 
lar surfaces. The injection of a strong solution of silver 
nitrate in the early stage of the disease has been advocated by 
some as a method of aborting gonorrhoea. Buboes have been 
successfully treated by the injection, after puncture, of a 2 per 
cent, solution of the nitrate, and in punctured wounds the in- 
jection of a solution of the strength of .60 gm. (10 gr.) to 30 
c.c. (1 fl. oz.), after the wound has been disinfected, has been 
recommended for preventing the development of tetanus. 
28 



41 8 PHARMACOLOGY AND THERAPEUTICS. 

Uniting, as it does, an irritant stimulating, with an astringent, 
effect, lotions of the salt, the strength of which is usually about 
.30 gm. (5 gr.) to 30 c.c. (1 fl. oz.) of water, are often of 
great service as an application for chronic pharyngitis or laryn- 
gitis and indolent ulcers, or as an injection in gleet or inflam- 
mation of the cervix uteri, while weaker solutions are used for 
various forms of ophthalmia. Ophthalmia neonatorum is suc- 
cessfully treated by early applications of a 1 per cent, aqueous 
solution of silver nitrate. This is commonly known as Crede's 
method, but the original formula as prescribed by him was double 
this strength. In spasmodic stricture of the oesophagus the oc- 
casional use of a very weak solution by means of a sponge pro- 
bang may prove of service. A solution containing 1.20 gm. (20 
gr.) to 30 c.c. (1 fl. oz.) is efficient in pruritus vulvae and in 
the prevention of bed sores, and the injection in small quan- 
tities of a solution varying from this strength up to one which 
is three or four times as concentrated into the sac of a hydrocele 
or cystic tumor has been attended with good results. Irrigation 
of the bowel with a solution of from .30 to .60 gm. (5 to 10 gr.) 
to 30 c.c. (1 fl. oz.) is often useful in pseudomembranous en- 
teritis, while prolapsed rectum, especially in children, is bene- 
fited by cauterization with mitigated silver nitrate. 

A useful injection in gonorrhoea is silver caseinate (Argonin, 
not official) in 1.5 per cent, solution which causes the speedy 
disappearance of gonococci, but since this is not astringent, 
other remedies must be employed to relieve the inflammation. 
Silver lactate (Actol, not official) is used as an antiseptic in 
sore throat, gonorrhoea, etc., in a 2 per cent, solution. Silver 
citrate (Itrol, not official) in 1 to 4000 solution is employed for 
the same purpose. Protargol (not official), a proteid compound 
containing 8 per cent, of silver easily soluble in water, is used 
as an injection for gonorrhoea. The usual strength is 1 per 
cent. Argentamine (not official), a 10 per cent, solution of 
silver nitrate in a 10 per cent, solution of ethylendiamine, has 
been used in gonorrhoea and conjunctivitis in a 1 to 4000 solu- 
tion; also as a disinfectant. This sterilizes a pure culture of 



SILVER SALTS. 419 

gonococci in from five to seven minutes. It can be used in as 
strong a solution as 1 to 1000 in the urethra, it penetrates deeply 
into the tissues without altering them, and by the seventh day 
the discharge is usually quite thin and gonococci can hardly be 
found. It then disappears rapidly. The iodide possesses the 
general properties of the nitrate. 

Silver, soluble in water, an allotropic form discovered about 
1890, now termed colloidal silver (not official), has recently 
been well received and has obtained a permanent place in thera- 
peutics. It is employed as a 15 per cent, ointment (Crede) by 
inunction. It has been used successfully for chronic furun- 
culosis, phlebitis and other septic processes. Largin (not offi- 
cial) is an albumin-silver compound, containing in the air- 
dried condition 11 per cent, of silver, which is said to be a 
powerful astringent and germicide, non-irritant, and not pre- 
cipitated by chlorides or albumin. It is used in gonorrhoea in 
solutions of from % to i J / 2 per cent. Silver fluoride (not 
official) has been recommended as an efficient application in 
anthrax. It is a dark-colored hygroscopic mass, readily soluble 
in water, equal in caustic effect to the nitrate, and powerfully 
antiseptic, being destructive to the anthrax bacillus, while non- 
toxic to man. Silver and sodium hyposulphite (not official), 
which is also very soluble in water and does not coagulate 
albumin, or stain the skin or the clothing, is preferred by some 
to silver nitrate for local application to the throat, on account 
of its being less disagreeable to the taste. 

Argyrol or silver vitellin (not official) is a very recent prep- 
aration, which, it is claimed, is distinguished from other silver 
salts by the high amount of silver it contains (30 per cent.), its 
intense penetrating action on the tissues, its freedom from irri- 
tating properties, and its power to allay the signs and symptoms 
of inflammation. In spite of its large percentage of silver, a 
20 per cent, solution of argyrol may be dropped in the normal 
conjunctival sac without producing irritation or discomfort, 
while the penetrating action of the salt is demonstrated by its 
action on catgut, a strand of which, after immersion in the 



420 PHARMACOLOGY AND THERAPEUTICS. 

solution, is found to be penetrated through and through with 
the argyrol. Hence it is argued that argyrol will exert the 
antiseptic effects of silver in the deep submucous structures 
where, in most pathological conditions, pathogenic organisms 
find and maintain lodgment in spite of energetic measures to 
eradicate them. Practically the remedy, topically applied, has 
proved of service in various diseases of the eye, ear, nose, 
throat and genito-urinary organs, as well as in a number of 
surgical conditions. It appears to be especially efficient in the 
treatment of gonorrhoea (which may sometimes be aborted by 
it) and of purulent conjunctivitis (of the new born, gonorrhceal, 
etc.). In trachoma the lids may be painted with a 25 per cent, 
solution, and a 2 per cent, solution, used by instillation, is said 
to be a certain prophylactic against ophthalmia neonatorum. It 
is stated to be the only silver salt which does not permanently 
stain the conjunctiva. Laryngologists who have employed 
argyrol in different conditions of the larynx and pharynx re- 
port that it seems to be quite as effective as silver nitrate, while 
it is far more agreeable to the patient. Argyrol has also been 
used internally, in place of silver nitrate, in the treatment of 
gastric ulcer, gastritis, gastro-enteritis, etc. It is claimed for it 
that, taken internally, it is absolutely non-toxic, is not absorbed, 
and is unchanged in the stomach or intestine; hence, with it, it 
is possible to secure the local effects of silver directly upon the 
affected portions of the mucous membrane. It is advised that 
it should be taken, in doses of .30 to .60 gm. (5 to 10 grs.), in 
capsules, followed by a glass of water, three times a day. 

Internal. — Silver salts were formerly employed to a con- 
siderable extent in nervous diseases, in which they were sup- 
posed to be in some way efficacious, and the nitrate especially 
was largely used in the treatment of epilepsy. At the present 
day its long continued administration is wholly unjustifiable on 
account of the objectionable discoloration of the skin to which 
it gives rise, while we have at our disposal other remedies which 
are far more efficient. Indeed, it seems very unlikely that sil- 
ver reaches the central nervous system in any other form than 



SILVER SALTS. . 42 1 

inert granules. There are, however, some conditions met with 
in the alimentary canal in which it is considered of value, and 
if it is not used too freely, or for too long consecutive periods, 
there would appear to be little risk of inducing argyria. There 
is no case on record, it is stated, of the latter having been 
caused by less than 30 gm. (1 oz.) of silver nitrate. The gums 
should be examined from time to time, as it has been found that 
the cutaneous pigmentation is preceded by the development on 
the edge of the gum of a dark line, which is removable by a 
course of acid potassium tartrate. On account of the conversion 
which takes place in silver salts upon reaching the stomach it is 
somewhat perplexing to explain the remedial action of silver 
nitrate as an internal remedy, but clinical experience seems to 
show that it is of service in gastric ulcer and in chronic gastric 
catarrh and gastritis accompanied with sour eructations or 
with vomiting after meals. In the treatment of ulcer it is 
recommended that it should be given in pill form with extract 
of hyoscyamus or opium. Combined with opium it has been 
found effective in the diarrhoea of phthisis, and with opium and 
ipecacuanha, in the diarrhoea of typhoid fever. It has also been 
employed in other forms of diarrhoea and in dysentery. In in- 
testinal ulceration it has been highly recommended, it being 
advised that under these circumstances the drug should be 
administered in hard or keratin-coated pills, in order that it 
may pass through the stomach without being chemically 
changed. In ulceration of the caecum and rectum, as well as 
in dysentery, rectal or colonic injections of silver nitrate are 
no doubt preferable. From .60 to 1.20 gm. (10 to 20 gr.) to 500 
c.c. (1 pint) of water may be employed for this purpose. For 
high injections a flexible tube should be used, and the bowel 
should be washed out with tepid water previous to the intro- 
duction of the silver solution. As silver nitrate when given by 
the mouth is usually associated with opium or other remedies, 
it would seem open to question whether much of the benefit 
apparently attending its use in affections of the gastro-intestinal 
tract may not in reality be due to these other drugs. For use 



422 .PHARMACOLOGY AND THERAPEUTICS. 

in stomach troubles some prefer silver oxide to the nitrate, 
on account of its less caustic qualities. 

Colloidal silver, which is entirely soluble in water and in 
albuminous fluids, is unirritating, so that it can be administered 
hypodermatically and intravenously as well as by inunction, as 
is mentioned above. For internal use, to prevent its conversion 
into a chloride in the stomach, it is first dissolved in equal parts 
of albumin and glycerin. The dose of o.i gm. ( gr.) may be 
given two or three times daily. It is claimed that it has a very 
beneficial influence and often affords a rapid cure in recent and 
also in chronic sepsis when secondary changes in the vital 
organs have not occurred. It seems to inhibit the action of 
staphylococci and streptococci, or destroy them altogether. It 
has been used in various conditions: osteomyelitis, so-called 
gonorrhceal rheumatism, puerperal fever, cerebro-spinal menin- 
gitis, and septic processes in general. Thus far no instance of 
argyria from its use has been reported. 

TOXICOLOGY. 

The nitrate sometimes causes acute poisoning. 

Symptoms. — These are intense pain in the abdomen and muscular 
spasm, followed by vomiting, and generally purging. The face is livid 
and covered with perspiration. The vomited matter is black and con- 
tains coagulated mucus. If the salt is in solution, the mucous mem- 
brane of the mouth will be covered with a grayish-white membrane, 
which afterwards becomes dark-colored. Should the case terminate 
fatally, the post-mortem appearances are those commonly met with in 
acute corrosive poisoning. Chronic poisoning or argyria shows itself 
by a permanent slaty discoloration of the skin, conjunctivae and labial 
mucous membrane and ulcerations in the digestive tract. 

Treatment. — This consists of administering a solution of sodium chlo- 
ride (common salt), soothing the mucous membranes by injection of 
milk, and relieving pain with opium. The chronic form is avoided by 
interrupting the treatment, using eliminating remedies, and preventing 
staining of the skin by baths of sodium hyposulphite. 

ZINC SALTS. 

1. ZINCUM.— Zinc. 

2. ZINCI CHLORIDUM.— Zinc Chloride. (Butter of Zinc.) 






ZINC SALTS. 423 

Preparation. 
Liquor Zinci Chloridi. — Solution of Zinc Chloride. 

3. ZINCI SULPHAS.— Zinc Sulphate. (White Vitriol.) Dose 
(emetic), 1 gm.; 15 gr. 

4. ZINCI CARBONAS PR^CIPITATUS.— Precipitated Zinc Car- 
bonate. 

5. ZINCI OXIDUM.— Zinc Oxide. Dose, 0.250 gm. (250 mil- 
ligm.); 4 gr. 

Preparation. 
Unguentum Zinci Oxidi. — Ointment of Zinc Oxide. 

6. ZINCI ACETAS.— Zinc Acetate. Dose, 0.125 gm. (125 mil- 
ligm.) ; 2 gr. 

7. ZINCI STEARAS.— Zinc Stearate. 

Preparation. 
Unguentum Zinci Stearatis. — Ointment of Zinc Stearate. 

Unofficial Preparation of Zinc. 
Oleatum Zinci (U. S. P., 1890).— Oleate of Zinc. 

Action of Zinc Salts. 

External. — Zinc chloride is an energetic corrosive. It causes 
much pain and penetrates deeply, but is valuable as a caustic 
for the reason that its action is limited to the seat of application. 
It is strongly antiseptic, and constitutes the chief ingredient of 
Burnett's fluid, a well-known domestic disinfectant. Solutions 
of the chloride of moderate strength are excitant, astringent and 
slightly haemostatic. The other zinc salts are also astringent 
and mildly haemostatic, thus acting like those of silver and lead, 
though their action is less powerful. The most active of them 
are the sulphate and acetate, the oxide, stearate and precipi- 
tated carbonate being quite feeble astringents. 

Internal. — Zinc chloride is a violent corrosive poison to the 
alimentary canal, causing a burning pain in the mouth, throat 
and abdomen, with vomiting and purging, followed by collapse. 
The matter vomited is likely to contain blood and shreds of 



424 PHARMACOLOGY AND THERAPEUTICS. 

mucous membrane, and the stools may also contain blood. 
Zinc salts, as a rule, act as astringents upon the gastro-intestinal 
mucous membrane, as well as upon the abraded skin and ulcer- 
ated surfaces. They are believed to have a somewhat specific 
irritant action, affecting at first exclusively the nerve structures 
in the stomach which form the starting point of the vomiting 
reflex; consequently emesis occurs before there is time for 
corrosion, and even very large amounts may be free from dan- 
ger. The most typical in its action is the sulphate, which in 
doses of I to 1.20 gm. (15 to 20 gr.) is a very prompt emetic. 
Its action is so rapid that there is no time for nausea, and its 
depressing effects are also very slight. 

Remote Effects. — The general action of zinc salts can be 
observed only when they are thrown directly into the circula- 
tion. Injected intravenously, they appear to depress the cen- 
tral nervous system, and to a less extent the heart and volun- 
tary muscles, and to cause irritation and congestion of the 
gastro-intestinal mucous membrane, as well as inflammation of 
the kidney. Emesis is one of the effects produced, and this is 
thought to be probably due to the inflammation of the stomach 
induced by the metal, rather than to any direct action upon 
the medullary centre for vomiting. Zinc has been found to 
possess a special affinity for the haemoglobin of the blood, 
with which it forms a compound (zinc-haemol), but its ad- 
ministration has no effect on the formation of haemoglobin. 
Zinc is excreted by the stomach and intestinal walls, and 
in much smaller amounts in the bile and urine. Of the 
zinc absorbed from the stomach and intestine, most is found 
to be contained in the liver and bile. Less of it is met 
with in the spleen, kidney, thyroid and pancreas, and very 
little in the other tissues. It is said that the exhibition of 155 
gm. of zinc carbonate, in the course of 335 days, induced no 
appreciable effects in the dog, and that the continued adminis- 
tration of zinc salts has no effect in man, except those of dis- 
ordered digestion and constipation. Workers in zinc are occa- 
sionally the subjects of what is known as " brassfounders' ague," 



ZINC SALTS. 425 

an affection which is apparently due to the fumes of zinc which 
escape in the process of casting. After a period of general 
malaise, followed by prolonged rigors and shivering, soreness 
of the chest occurs, accompanied by coughing and headache. 
Then profuse perspiration supervenes and the patient falls into 
a deep sleep, from which he awakes in ordinary health. A 
number of obscure nervous conditions have been described as 
being caused by zinc in those who work with the metal, but 
they appear to be extremely rare, and when present may pos- 
sibly be due to arsenic, lead, or other impurities occurring in 
zinc compounds. 

Therapeutics of Zinc Salts. 
External. — Zinc chloride is an effective caustic for morbid 
growths, such as epitheliomata, nsevi, warts and condylomata, 
and for gangrenous sores. It may be applied in the form of a 
pencil made with plaster-of-Paris or of a paste made with 
starch, flour or dried gypsum. Canquoin's paste is a mixture 
of zinc chloride in varying strength with wheat flour and water. 
In malignant disease of the uterus the chloride has been used 
both in paste and in saturated solution applied by means of a 
tampon. Injections of zinc chloride (about 1 c.c. ; 15 Til of 
a 1 per cent, solution) have sometimes been made into the 
tissues in the vicinity of the fracture, for the purpose of pro- 
moting the union of fractured bones, and in a case of recurrent 
luxation of the shoulder the tendency to dislocation is stated 
to have been overcome by a number of injections of .12 c.c. 
(2 TT1) of a 10 per cent, solution into the anterior superior por- 
tion of the capsule below the acromion process. The same 
plan of treatment has also been applied in tuberculosis of joints 
and in lupus, and even in the early stages of pulmonary tuber- 
culosis minute quantities of such solutions have been injected 
into the lung, with the object of favoring the formation of 
fibrous tissue and thus arresting the disease. Liquor Zinci 
Chloridi, much diluted, may be employed as a detergent and 
stimulating application to old sores and as a disinfectant for 






426 PHARMACOLOGY AND THERAPEUTICS. 

wounds. Either the Liquor, or Burnett's fluid (which is a 
somewhat stronger solution), is sometimes used to disinfect 
faeces, urinals, closets, etc. Piatt's chlorides is said to consist 
of various salts of zinc, chiefly the chloride, in saturated 
solution. Lotio Rubra, a solution of the sulphate (generally 
about 1 to 240), colored red with compound tincture of lavender, 
is used as an astringent application to abraded surfaces, ulcers, 
etc., and as an injection in gonorrhoea, leucorrhcea, or otitis. 
Either alone or combined with other agents, zinc sulphate is 
very commonly employed as an injection in gonorrhoea and 
gleet and as a collyrium in conjunctivitis. The acetate (.03 to 
.06 c.c. ; y 2 to 1 gr.) in rose-water (30 c.c. ; 1 fl. oz.) is also 
useful for the latter purpose. The oxide, stearate and precipi- 
tated carbonate, either dusted on the part or in the form of oint- 
ment, may be employed in a great variety of conditions where 
only a mild astringent effect is required. The ointment of zinc 
oxide is perhaps more widely used than any other as a protective 
and slightly astringent application to acute skin affections, and 
to it are frequently added phenol, oil of cade, tar, and various 
other agents, according to the case, for the treatment of eczema, 
herpes, erysipelas, burns, etc. What is known as Unguentum 
Metallorum, which consists of equal parts of the ointments of 
zinc oxide, lead acetate, and diluted mercuric nitrate, is a ser- 
viceable application for some forms of eczema and other skin 
diseases, as well as for sores and ulcers. Another useful oint- 
ment, which has the advantage of being transparent, is the one 
already referred to (see p. 409) composed of equal parts of zinc 
oleate, mercuric oleate, and diachylon ointment. For pruritus 
the following combination is recommended : Zinc oxide, 25 ; 
gelatin, 20 ; glycerin, 60 ; water, to 480. This compound is to be 
melted and applied with a brush, after which the part should be 
covered with cotton. Unna's zinc-glue, which, when rubbed 
into the gauze or muslin of a bandage, forms a stiff surgical 
dressing, consists of 10 parts of zinc oxide, and 30 parts each 
of gelatin, glycerin and water. Good preparations of calamine 
(purified zinc carbonate), which is efficacious as a mild astring- 



ZINC SALTS. 427 

ent for cutaneous affections, are the following: An ointment 
with benzoated lard (1 to 5) and a lotion consisting of calamine, 
3; zinc oxide, 3; glycerin, 4; lime-water, 16; water, 60. 

Internal. Alimentary Canal. — Zinc chloride is not given in- 
ternally. The sulphate was formerly much employed to pro- 
duce vomiting in cases of croup, but has now for the most part 
been superseded by other remedies. It is, however, a very ser- 
viceable emetic in narcotic and other poisoning, where prompt 
and efficient action is required. It is quite safe so long as the 
mucous membrane is intact, for under these circumstances it is 
not absorbed. Practically, however, it always produces some 
irritation of the gastric walls, and its use should therefore be 
limited to cases in which the poison is not injurious to the stom- 
ach itself. Its only advantage over apomorphine appears to con- 
sist in a less degree of nausea and depression. In doses of .03 
to .12 gm. (y 2 to 2 gr.) it has been found to afford great relief 
in that form of dyspepsia which gives rise to oxaluria. Both 
the sulphate and oxide are occasionally given in chronic diar- 
rhoea and dysentery. The oxide is useful in gastralgia, and has 
been recommended, usually in association with other drugs, 
when the following conditions are present: pain after eating, 
nausea, and intestinal pain, succeeded by prompt evacuation 
of the bowels, the faeces being made up largely of undigested 
food. In the summer diarrhoea of children it is sometimes ad- 
ministered with bismuth and pepsin, and to diminish the crav- 
ing for alcohol and relieve the gastric catarrh of drunkards it 
has been employed in combination with piperin. 

Remote Effects. — The preparations of zinc have been thought 
to exert an antispasmodic influence upon the nervous system, 
and the sulphate and oxide were formerly employed to a con- 
siderable extent in the treatment of such affections as epilepsy, 
chorea, hysteria and whooping-cough. Their efficacy is doubt- 
ful, however, and they have now largely fallen into disuse as 
nervous depressants. The oxide is of some service in checking 
the night-sweats of phthisis, particularly when combined with 
extract of belladonna, but it is quite likely to interfere with 



428 PHARMACOLOGY AND THERAPEUTICS. 

the digestion. Trousseau's pill for this purpose consists of zinc 
oxide, .30 gm. (5 gr.), with extract of hyoscyamus, .06 gm. 
(1 gr.). Zinc bromide, iodide, phenosulphonate and valerate 
are considered elsewhere. 

TOXICOLOGY. 

The appearances met with after death from zinc chloride are those 
which commonly characterize the action of a gastro-intestinal irritant. 
The sulphate, in large doses, also acts as an irritant poison, producing 
colicky pains, diarrhoea and prostration. 

Treatment. — The salt itself usually produces such prompt and copious 
vomiting that other emetics are scarcely required, but these may be 
given (see p. 175), or the stomach may be washed out. Demulcents 
should then be administered : lime-water, mucilaginous drinks, and al- 
bumin freely in the form of eggs or milk. 

COPPER SULPHATE. 
CUPRI SULPHAS.— Copper Sulphate. (Cupric Sulphate. Blue 
Vitriol. Bluestone.) Dose (astringent), 0.010 gm. (10 milligm.) ; 
i/ 5 gr.; (emetic) 0.250 gm. (250 milligm.); 4 gr. 

Unofficial Preparation of Copper. 
Oleatum Cupri. — Oleate of Copper. 

Action of Copper Sulphate. 

External. — Used in substance, it is somewhat corrosive. In 
solution it acts like zinc sulphate, but is more strongly astringent 
and antiseptic. 

Internal. Alimentary Canal. — In moderate doses it is a 
prompt and efficient emetic, acting in precisely the same man- 
ner as zinc sulphate, though it is more irritant. In large quan- 
tities it causes corrosion of the gastro-intestinal mucous mem- 
brane, with violent vomiting and purging. In small doses it 
is markedly astringent. 

Remote Effects. — Small amounts may be taken for an indefi- 
nite period without giving rise to any appreciable effect, so 
that the general action of copper salts in man is unknown. In 
animals their intravenous injection in sufficient quantity in- 
duces paralysis of the spontaneous movements and of the heart 






COPPER SULPHATE. 429 

and respiration, the respiration failing somewhat earlier than 
the heart. The blood-pressure at first rises, and afterwards falls, 
in consequence of the failure of the vaso-motor nerves to main- 
tain the contraction of the vessels, as well as from the weakness 
of the heart itself. According to most observers, no emesis is 
induced, so that it seems certain that the vomiting resulting 
from the administration of copper salts by the mouth is due 
to the gastric irritation, and not to any direct action on the 
central nervous system. If the animal survives long enough, 
violent and perhaps bloody diarrhoea is generally observed. 
Copper is absorbed from the stomach and intestine, and also 
from other mucous membranes and from wounds, and the metal 
is stored chiefly in the liver, though it is found in smaller 
amount in the spleen, kidney and thyroid. It is excreted in the 
intestinal secretions, bile, urine, saliva and milk, and is said to 
pass from the mother to the foetus in utero. It is stated to 
have a strong affinity for haemoglobin, forming with it a com- 
pound called cuprohsemol, but, like zinc, does not increase the 
haemoglobin of the blood. Animals have been fed with food 
containing considerable amounts of copper for many months at 
a time without showing any special evidence of poisoning, and 
this metal, it is said, is found so regularly in the tissues of man 
and animals that it may be regarded as a normal constituent, 
although its function is quite unknown and it may be merely 
stored up on its way to excretion. 

Therapeutics of Copper Sulphate. 
External. — As a caustic it is milder in action and also less 
painful than silver nitrate. In solid form or powder it is applied 
to indolent ulcers and granulations, syphilitic and other sores in 
the mouth and throat, granular lids, corneal ulcers, etc. In 
weak aqueous solution it is sometimes employed in subacute 
conjunctivitis, but the acetate is preferable for this purpose. 
In place of the pure sulphate, what is known as Lapis Divinus 
may be used as a caustic. It consists of copper sulphate, potas- 
sium nitrate, and alum, each 24 parts, and camphor, 1 part. 



430 PHARMACOLOGY AND THERAPEUTICS. 

The camphor is added after the other ingredients have been 
fused together, and the whole mass is then cast into cylindrical 
moulds. Lotions of copper sulphate are more strongly astringent 
than those made with zinc sulphate, but are often employed for 
the same purposes in the strength of about i to 240. In this 
strength it may be instilled into the eye. Somewhat more con- 
centrated solutions have a mild haemostatic effect, and the solid 
salt is also serviceable for checking haemorrhage from slight 
wounds, leech bites, and irritable ulcers. Associated with zinc 
sulphate and lead acetate, or with fluid extract of geranium or 
other remedies, copper sulphate is used to a considerable ex- 
tent in gonorrhoea, and weak solutions of it also make good 
injections for vaginitis, leucorrhcea and gleet, as well as good 
stimulant dressings for chancres and chancroids. In the 
strength of from .60 to 1.20 gm. (10 to 20 gr.) to 30 c.c. (1 fl. 
oz.) of menstruum it is sometimes thrown into the bowel for 
the relief of chronic diarrhoea and dysentery and of acute 
diarrhoea of severe form, and a solution of .30 to .60 gm. (5 
to 10 gr.) in 30 c.c. in glycerin has been recommended as an 
injection in pseudomembranous enteritis. An aqueous solution 
of .30 gm. (5 gr.) or more to 30 c.c. (1 fl. oz.) may be used 
with good effect as a gargle in relaxed sore throat and as an 
application for hyperidrosis or bromidrosis. A solution of 30 
gm. (1 oz.) in 500 c.c. (1 pint) of water is said to be very 
efficacious in the treatment of scabies, and in weaker solutions 
and ointments copper sulphate is of service in psoriasis, sycosis 
and other forms of tinea, acne, chronic eczema, and other skin 
diseases. Thus, oleate of copper (not official), made with lano- 
lin into a 10 to 20 per cent, ointment, is an excellent parasiticide 
for ringworm. 

Internal. — As an emetic it is used in the same class of cases 
as zinc sulphate. As it is more irritant than the latter, the 
stomach should be promptly evacuated by some other means 
in any case in which it fails to produce vomiting. On account 
of its irritant effect some would restrict its use as an emetic to 
cases of phosphorus poisoning, in which it has been supposed 



COPPER SULPHATE. 43 I 

to be particularly serviceable on account of the possible deposi- 
tion of copper on the particles of phosphorus preventing the 
absorption of the latter. It is extremely doubtful, however, 
whether copper sulphate is especially valuable in this way. In 
acute dysentery it may be given with advantage combined with 
magnesium sulphate and dilute sulphuric acid, and, after the 
acute symptoms have subsided, with morphine or opium. Asso- 
ciated with opium, it is a useful palliative astringent in the 
diarrhoea of phthisis, and of all the metallic astringents in 
use, it has been pronounced the most effective in chronic diar- 
rhoea and chronic dysentery. It is regarded as indicated when 
colicky pains and tenesmus are present, and the stools, partly 
feculent, contain mucus streaked with blood, and it may be 
given in pill form in doses of .005 gm. (yL- gr.) combined with 
the same amount of morphine sulphate and .12 gm. (2 gr.) of 
quinine sulphate. When tolerance of the copper sulphate is 
established, it is advised that the dose should gradually be in- 
creased to .015 gm. (34 g r -)- I n gastro-intestinal catarrh 
also minute doses of it are of service. In some states of the 
body, particularly in cutaneous affections of the dry type and 
in persons with tubercular tendencies, it is thought to act like 
arsenic, and may be given in cases in which that drug is not 
well borne. It has been used in anaemia and chlorosis, and 
has also been recommended in the treatment of syphilis. 

TOXICOLOGY. 

Acute poisoning. — The copper is apt to give a blue or green tinge 
to the vomit and faeces, and later blood appears in them from the cor- 
rosion of the mucous membrane. There is intense abdominal pain, and 
the usual symptoms of acute corrosive poisoning may follow — collapse, 
with weak pulse and respiration, cold, clammy skin, dizziness, uncon- 
sciousness, delirium, coma, convulsions and paralysis. 

Chronic poisoning. — This is a matter of great practical interest. 
Preserved peas and other vegetables, the green color of which is due 
to preparation with copper, are in common use by the public. Copper 
is also added to flour to improve the bread made from it, and it may 
enter the food from the use of cooking utensils made of this metal 



432 PHARMACOLOGY AND THERAPEUTICS. 

and in a variety of other ways. No deleterious effects appear, as a 
rule, to result from such introduction of copper into the system, and it 
has been disputed whether chronic copper poisoning occurs in man at 
all ; especially as it is claimed that copper may be taken directly, either 
in the form of the metal or of its soluble salts, for prolonged periods 
without the production of any symptoms except perhaps more or less 
nausea and the evidences of a mild intestinal catarrh. Still, the facts 
show unquestionably that instances of chronic poisoning are occasion- 
ally met with. Among workers in copper and brass the skin and hair 
not infrequently have a greenish tint, while the upper borders of the 
teeth may show a green discoloration which is known as the " copper 
line." In addition, colic and diarrhoea, or acute febrile attacks of gas- 
trointestinal catarrh, which may be followed by local paralysis, are 
sometimes observed, and the following symptoms have also been noted : 
anaemia, wasting, dyspepsia, tremors, headache, vague pains, pharyngeal 
and laryngeal catarrh with occasional haemoptysis and aphonia, and 
profuse secretion of sweat, which may be of a greenish hue. The oc- 
currence of these various manifestations has been attributed in part 
to the deposit of copper dust upon the skin, hair and teeth, and in part 
to the lead, arsenic and other poisons often associated with copper. It 
would seem altogether probable that in a considerable proportion of 
instances such an explanation will suffice for the symptoms present, but, 
on the other hand, certain cases come under observation from time to 
time in which the evidences of chronic poisoning are indisputably due 
to copper alone. 

Treatment. — For acute poisoning give albumin, milk or magnesia. 
Potassium ferrocyanide is the chemical antidote. Then promptly empty 
the stomach and saturate the system with potassium iodide. Chronic 
poisoning is best treated by the administration of fifteen drops of diluted 
phosphoric acid before each meal, the ingestion of large quantities of 
milk, and thorough daily evacuation of the bowels with magnesium or 
sodium sulphate. 

ALUMINUM SALTS. 

1. ALUMEN. — Alum. (Aluminum and Potassium Sulphate. Potas- 
sium Alum.) Dose, 0.500 gm. (500 milligm.) ; iy 2 £*• 

Preparation. 
Alumen Exsiccatum. — Dried Alum. (Burnt Alum.) • 

2. ALUMINI HYDROXIDUM.— Aluminum Hydroxide. (Alumi- 
num Hydrate.) 

3. ALUMINI SULPHAS.— Aluminum Sulphate. 



ALUMINUM SALTS. 433 

Unofficial Preparations of Aluminum. 
Alumini Acetas. — Aluminum Acetate. 
Glyceritum Aluminis. — Glycerite of Alum. 
Alumnol. — Alumnol. (Aluminum Naphthol-Sulphonate.) 

Action of Aluminum Salts. 

External. — Aluminum salts in solution are astringent and 
haemostatic, throwing down a layer of precipitated albumin on 
the surface of mucous membranes and on raw surfaces; also 
coagulating the albumin in the underlying tissues, and thus con- 
stricting the blood-vessels. In concentrated form they act as 
irritants, and dried alum, by reason of its marked avidity for 
water, is somewhat escharotic. On account of their property 
of precipitating proteids aluminum salts are antiseptic, as well 
as astringent, and in particular the acetate (not official) in 
saturated solution is a very penetrating antiseptic. In haemor- 
rhage, when the leaking vessels can be directly reached, alum 
is a valuable haemostatic, as it acts in three ways to arrest the 
bleeding: coagulating the albumin, constringing the parts, 
and, by crystallizing when applied in large amounts on lint, 
affording a surface which is rough and aids coagulation. 

Internal. Alimentary Tract. — They have a purely local 
action, not being absorbed to any extent from the alimentary 
canal, and even very large amounts cause only a local exudative 
inflammation (in consequence of the precipitation of proteids) 
which is characterized by nausea and vomiting and in extreme 
cases by purging. In small doses they act as astringents upon 
the mucous membrane of the mouth, stomach and intestine, and 
usually cause constipation. In larger doses they are mechanical 
emetics. On account of the lack of absorption, no symptoms of 
general poisoning are induced by their internal administration, 
and their long-continued use is never attended with evidences 
of chronic poisoning. Locally, however, they have, as has been 
mentioned, a decided action, and it is probably true that their 
continued administration in even small doses will produce dele- 
terious effects. 
29 



434 PHARMACOLOGY AND THERAPEUTICS. 

Remote Effects. — The general action of aluminum salts is 
seen only when they are thrown directly into the circulation. 
Aluminum, like various other metals, acts on the intestine and 
kidney, and also appears to have a direct action on the brain. 
The intoxication is a very slow one, the symptoms appearing 
only several days after the intravenous injection, at a time when 
the metal has entirely disappeared from the blood, and has be- 
come fixed in the cells. In mammals the first symptoms are ob- 
served in from three to five days, and are found to consist in 
constipation, rapid loss of weight, weakness, torpor and vomit- 
ing. Later, marked abnormalities in movement and sensation 
are noticed, such as tremor, jerking movements, clonic con- 
vulsions, paresis of the hind legs, anaesthesia of the mouth and 
throat, and lessened sensation over all parts of the body. 
Eventually diarrhoea and albuminuria are generally noted. 
After death there are found swelling and congestion of the 
gastro-intestinal mucous membrane, fatty degeneration of the 
liver and kidney, and haemorrhages in the cortex of the latter 
organ; while aluminum is found in the urine. It has recently 
been shown also that the nerve cells of the spinal cord and 
medulla oblongata, and particularly those of the lower cranial 
nerves, undergo degeneration. What little aluminum is ab- 
sorbed from the alum salts of the food is thought to be rapidly 
excreted by the intestine and perhaps by the kidney. 

Therapeutics of Aluminum Salts. 
External. — Alum is in general use as a local astringent. 
Thus, solutions of it are applied on lint or injected in the vul- 
vitis of children, and are used as injections in leucorrhoea, 
gonorrhoea, gleet, chronic cystitis, dysentery, and haemorrhage 
from the rectum. Alum, dissolved in infusion of logwood, is 
often an efficient application for prolapsus of the rectum in 
children. In powder or strong solution it is serviceable as a 
styptic for capillary haemorrhage from wounds, haemorrhage 
after tooth-extraction, leech bites, epistaxis, bleeding from the 
gums, bleeding piles, etc. An excellent styptic combination 



ALUMINUM SALTS. 435 

consists of equal parts of glycerite of alum (not official), alcohol 
and soap liniment. The topical application of powdered alum 
is sometimes very useful in chronic pharyngitis, tonsillitis and 
nasal catarrh, and in ozsena the nasal chambers may be irrigated 
with a solution containing 4 gm. (1 dr.) to 500 c.c. (1 pint) 
of water. A solution of about the strength of .30 gm. (5 gr.) 
to 30 c.c. (1 fl. oz.) of water is employed as a gargle, and 
gargling the throat with alum dissolved in a decoction of barley, 
to which a small quantity of honey of roses is added, is said 
to be of service to speakers or singers if practised shortly be- 
fore using the voice. Alum has been used in solution as a 
mouth wash for ulcerative stomatitis and mercurial ptyalism, but 
is objectionable for this purpose, as well as for making gargles, 
as it attacks the enamel of the teeth. For conjunctivitis a watery 
solution of the glycerite may be employed as a collyrium, and 
alum curd (2 gm. ; 30 gr., of alum beaten up with the white of 
a fresh egg) is also sometimes applied externally. A solution 
containing .30 gm. (5 gr.) each of alum, copper sulphate, zinc 
sulphate, and ferrous sulphate, to 30 c.c. (1 fl. oz.) of distilled 
water, to be brushed upon the inside of the lids, once daily, 
has been recommended in chronic granular conjunctivitis. The 
local astringent action of alum may be utilized for weeping 
eczema and purpura, and, dissolved in water to which whiskey 
or alcohol is added, it may be sponged over the surface for 
night-sweats or excessive sweating of the feet or hands, or 
employed to harden the nipples of pregnant women. Alum 
solutions are also more or less effective in the treatment of bed 
sores, chilblains, and ingrowing toe-nail. In the latter condi- 
tion a piece of twisted absorbent cotton saturated with a strong 
solution is inserted under the nail. A hot solution will some- 
times relieve pruritus vulvae, and ointments containing alum 
are often useful in herpes and bromidrosis. The dried powder 
is occasionally applied as an escharotic for destroying granu- 
lations and warty growths, and is also used to stimulate in- 
dolent ulcers and mucous membranes with morbid secretions. 
Aluminum naphthol-sulphonate (alumnol, not official), in i 



43^ PHARMACOLOGY AND THERAPEUTICS. 

to 3 per cent, solutions, is an unirritating astringent which, 
although precipitating albumin, dissolves it when in excess, 
and therefore penetrates below the surface. It is used for the 
treatment of acute and chronic inflammations of various mucous 
membranes. 

Internal. — It is said that .60 gm. (10 gr.) of alum, placed 
upon the tongue, will sometimes arrest a paroxysm of asthma. 
Not being depressing, alum is a good emetic, especially for 
children suffering from croup, bronchitis, etc. 4 gm. (1 tea- 
spoonful) of powdered alum, dissolved in syrup, may be given 
every fifteen minutes until vomiting is produced. As an internal 
astringent or haemostatic it is not as a rule as efficient as some 
other remedies, but in the form of alum whey (milk curdled 
by alum), it may often be given with advantage in cases of 
typhoid fever in which the diarrhoea calls for special treatment. 
In intestinal haemorrhage when dependent upon mechanical 
causes, such as cirrhosis, if the mucous membrane is free from 
acute inflammation, and in haematemesis when the haemorrhage 
is passive and the gastric mucous membrane relaxed, alum is 
likely to be of service. It may also be used in catarrh of the 
stomach, especially where there is vomiting of glairy mucus; a 
pill containing .24 gm. (4 gr.) of alum and .06 gm. (1 gr.) of 
extract of gentian being administered three times a day. Alum 
is one of the most effective of all remedies in the treatment of 
lead colic, and by many it is considered to relieve the pain and 
nausea and overcome the constipation of plumbism more 
certainly than any other agent. Its beneficial action is at- 
tributed by some to the fact that, being a sulphate, it 
precipitates any lead salts present in the intestine as in- 
soluble lead sulphates. Others, however, hold that the chem- 
ical theory of its action is entirely inadequate to account 
for its remarkable effects, believing that the conversion of 
any portion of the lead present into the insoluble sul- 
phate would not suffice to quiet pain, relieve flatulence, and 
relax the obstinately constipated bowels. The explanation they 
bring forward is that its action is doubtless dynamical, being 



KAOLIN. 437 

exerted upon the muscular layer of the bowel, on the abnormal 
condition of which the phenomena of lead colic depend. Still 
others, finding that alum is of service when there is no lead in 
the alimentary canal, state that it must act in some way as 
yet unknown. Being a soluble sulphate, as well as an emetic, 
alum may also be used as an antidote in acute lead poisoning. 
In the form of a very fine spray a strong solution of alum, 1.20 
gm. (20 gr.) to 30 c.c. (1 fl. oz.), is sometimes efficacious in 
haemoptysis, and such a spray may also be employed in bron- 
chorrhoea and in chronic catarrh of the pharynx and larynx. 

KAOLIN. 
KAOLINUM.— Kaolin. 

Preparation. 
Cataplasma Kaolini. — Cataplasm of Kaolin. (Kaolin Poul- 
tice.) 

Action of Kaolin. 

Kaolin is emollient and a drying agent; it has the power in 
a pronounced degree of clarifying and decolorizing oils, 
whether animal, vegetable or mineral. 

Therapeutics of Kaolin. 
Kaolin is an efficient dusting powder for inflamed surfaces 
and irritated conditions of the skin. As it is resistant to most 
chemical agents, it is used as a basis for making pills of such 
substances as phosphorus, silver nitrate, and potassium per- 
manganate, in which chemical reaction would ordinarily take 
place. An excellent substitute for poultices is made as follows : 
Kaolin, 1000 parts, is sifted and sterilized by heat; glycerin, 
1000 parts, is added (the heat being continued) and mixed by 
stirring for half an hour. When nearly cool, add boric acid, 
100 parts, and oil of peppermint, 1, oil of wintergreen, 1, and 
oil of eucalyptus, 2 parts. The Cataplasma Kaolini which is 
now official is made as follows: Kaolin, in very fine powder, 
577, is heated at ioo° C. (212 F.), with occasional stirring, 
for one hour, after which boric acid, 45, is mixed intimately 



438 PHARMACOLOGY AND THERAPEUTICS. 

with it and the mixture thoroughly incorporated with glycerin, 
375. Finally, thymol, 0.5, dissolved in methyl salicylate, 2, and 
oil of peppermint, 0.5, are added, and a homogeneous mass 
produced. Kaolin is employed to quite a large extent in 
clarifying oils, such as lard and cotton-seed oils and mineral 
lubricating oils, as well as wine, beer, honey, syrups, etc. 

3. Emollients and Demulcents. 

STEARIC ACID. 

ACIDUM STEARICUM.— Stearic Acid. 

Preparations. 
Zinci Stearas. — Zinc Stearate. 
Unguentum Zinci Stearatis. — Ointment of Zinc Stearate. 

Action of Stearic Acid. 
Stearic acid has no known general action upon man. 

Therapeutics of Stearic Acid. 
Stearic acid is used in the manufacture of glycerin supposi- 
tories. Stearates of zinc and copper (the latter unofficial) 
have been introduced and used with success in the treatment 
of various diseases of the skin and mucous membranes. 

WOOL-FAT. 
ADEPS LAKflB.— Wool-Fat. 

Preparation. 
Adeps Lanae Hydrosus. — Hydrous Wool-Fat. (Lanolin. 
CEsypum.) 

Action of Hydrous Wool-Fat. 
Hydrous wool-fat is very soothing to the skin, and when 
gently rubbed in is more quickly absorbed than most fats. 

Therapeutics of Hydrous Wool-Fat. 
As it assists the glandular functions of the skin, it is useful 
in comedo and anidrosis. In ichthyosis and scleroderma and 



ISINGLASS. 439 

in senile atrophy of the integument it softens the surface, and 
inunction with it is considered one of the best methods of 
obliterating wrinkles. It is serviceable as an application for 
chapped hands and lips, burns, scalds, frost-bite, erythema, 
impetigo contagiosa, dermatitis, erysipelas and acute eczema, 
and, when it contains a sufficient amount of water, is efficient 
in allaying the itching of scarlet fever and other exanthematous 
diseases. In chronic eczema with infiltration and in psoriasis it 
softens the skin and favors the action of remedies which may 
be combined with it. It is often an excellent basis for oint- 
ments expected to act especially upon the skin, but as it passes 
readily through the integument, it is not well adapted for a 
protective. It is a useful vehicle for remedies to be used by 
inunction, and on account of its penetrative power, as well as 
its ready miscibility with mercury, it is of peculiar value in 
the inunction treatment of syphilis. It is employed to a con- 
siderable extent also as a vehicle for cocaine in affections of 
the nose and genito-urinary tract, and for cocaine, morphine, 
atropine and other anodynes in neuralgias and painful joints. 
It is not used internally. 

ISINGLASS. 
ICHTHYOCOLLA (U. S. P., 1890; no longer official).— Isinglass. 
Unofficial Preparation. 
Emplastrum Ichtliyocollse (U. S. P., 1890). — Isinglass Plas- 
ter. (Court Plaster.) 

Action of Isinglass. 
Isinglass is an emollient and nutritive substance. 

Therapeutics of Isinglass. 
It is chiefly used externally as a protective. A better court 
plaster has goldbeaters' skin as a base. Salicylated isinglass 
plaster has the advantage of the antiseptic properties of salicylic 
acid. A codliver-oil jelly may be made by means of isinglass 
which, flavored with the oils of almond, cinnamon and allspice, 
is readily taken by children. 



440 PHARMACOLOGY AND THERAPEUTICS. 

LARD. 

1. ADEPS.— Lard. 

Preparations. 

1. Adeps Benzoinatus. — Benzoinated Lard. 

2. Ceratum. — Cerate. 

3. Ceratum Resinae. — Rosin Cerate. 

4. Ceratum Resinae Compositum. — Compound Rosin Cerate. 

5. Unguentum. — Ointment. 

2. OLEUM ADIPIS.— Lard Oil. 

• Action of Lard. 
Lard is one of the best emollients, its application to the skin 
being followed by a pleasant feeling of softness and flexibility. 
Melting at the temperature of the body, it is readily absorbed 
by the integument. The benzoated lard has the advantage of 
not quickly becoming rancid, but it is irritating to tender skins. 

Therapeutics of Lard. 
Lard has been used with some success as a soothing enema in 
dysentery. When the secretory formation of the skin is im- 
paired or suppressed, inunction with lard serves as a partial 
substitute for the natural secretion, and such inunction is some- 
times employed by professional rubbers as an aid to friction. 
It is also of service in chest affections. Washed lard, beaten 
up with an equal quantity of lime water, and a few drops of 
oil of bitter almond, thymol, or carbolic acid added, is said to 
make an elegant substitute for Carron oil as a dressing for 
burns, as well as for some acute inflammations of the skin. On 
account of its penetrating power, active agents, such as mer- 
cury and the alkaloids, can be combined with lard for adminis- 
tration by inunction, and its chief use in medicine is as a basis 
for ointments. 

SPERMACETI. 

CETACEUM.— Spermaceti. 

Preparation. 
Unguentum Aquae Rosas. — Ointment of Rose Water. 



CHAULMOOGRA OIL. 44 I 

Unofficial Preparation. 
Ceratum Cetacei (U. S. P., 1890). — Spermaceti Cerate. 

Action of Spermaceti. 
Spermaceti is emollient and demulcent. 

Therapeutics of Spermaceti. 
It is used almost entirely as a basis for ointments and cerates. 
In the form of powder, which may be obtained by triturating 
it with a little alcohol, spermaceti is sometimes employed, 
mixed with an equal weight of talc, as a dusting powder for 
the feet, for the purpose of preventing friction. 

EGG. 

Unofficial Preparations. 

1. Vitellus (U. S. P., 1890).— Yolk of Egg. 

2. Glyceritum Vitelli (U. S. P., 1890).— Glycerite of Yolk of 
Egg. (Glyconin.) Dose, freely. 

3. Ovi Albumin. — Egg Albumin. 

Action of Yolk of Egg. 
Yolk of egg is nutritive and emollient. 

Therapeutics of Yolk of Egg. 
It is used to make emulsions. 

Action of Egg Albumin. 
Like the yolk of egg, it is nutritive and emollient. 

Therapeutics of Egg Albumin. 
Egg albumin is an antidote to poisoning by corrosives and 
irritants, especially corrosive -mercuric chloride, copper sul- 
phate, lead salts, and silver nitrate. 

CHAULMOOGRA OIL. 

Unofficial Preparation. 
Oleum Gynocardiae.— Chaulmoogra Oil. Dose, 0.30 to 1.20 
c.c.; 5 to 20 m,. 



442 PHARMACOLOGY AND THERAPEUTICS. 

Action of Chaulmoogra Oil. 

It is a local irritant, apparently similar in character to can- 
tharidin and other agents of its class, though less energetic in 
its action. 

Therapeutics of Chaulmoogra Oil. 

It has been largely employed as a local application for bruises, 
sprains and stiffness by athletes, and also in veterinary practice. 
It is recommended as a stimulant in scaly eczema, psoriasis, 
ichthyosis, syphilitic cutaneous lesions, chronic rheumatism, etc., 
and for such purposes an ointment composed of 3 parts of 
chaulmoogra oil to 8 of lanolin may be employed. It is best 
known as a remedy for leprosy, in which it has been extensively 
tried both externally and internally. It is not apparently cura- 
tive, but the bacilli of the disease present in the blood have 
been shown to decrease in number under its use, and it is un- 
doubtedly one of the best agents at our command in this intract- 
able affection. Internally it is usually administered in capsules. 

PETROLATUM. 
PETROLATUM (Petrolatum Molle, Petrolatum Spissum, U. S. P., 
1890) . — Petrolatum. 
PETROLATUM ALBUM.— White Petrolatum. 
PETROLATUM LIQUIDUM.— Liquid Petrolatum. 

Action of Petrolatum. 

Petrolatum is purely emollient. None of the petroleums are 
nutritive. 

Therapeutics of Petrolatum. 

Petrolatum is used principally as a bland, neutral protective, 
and, because it does not become rancid nor act as an irritant, 
and as it is not affected by acids, alkalies or powerful reducing 
agents, it is employed as a substitute for fatty materials in oint- 
ments. But as it is absorbed with difficulty it is not a suitable 
vehicle for drugs which are intended for absorption through the 
skin. Liquid petrolatum has been used as a local soothing ap- 



cotton. 443 

plication in inflammation of the mucous membrane of the nose, 
throat, larynx, and even of the bronchial tubes, by means of 
an atomizer. It may also be employed as a vehicle for various 
medicinal substances. 

COTTON. 

1. GOSSYPIUM PURIFICATUM.— Purified Cotton. (Absorbent 
Cotton.) 

2. PYROXYLINUM.— Pyroxylin. (Gun Cotton.) 

Preparations. 

1. Collodium. — Collodion. 

2. Collodium Flexile. — Flexible Collodion. 

3. Collodium Cantharidatum. — Cantharidal Collodion. (Blis- 
tering Collodion.) 

4. Collodium Stypticum. — Styptic Collodion. 

3. OLEUM GOSSYPII SEMINIS.— Cotton Seed Oil. Dose, 16 
c.c; 4 fl. dr. 

Action of Cotton. 

None. 

Therapeutics of Cotton. 

Cotton is used in various forms as a covering, protection, or 
support, and also for the topical application of remedies. Ab- 
sorbent cotton, lint and gauze are frequently medicated, e. g., Sal 
Alembroth, 2 per cent.; Boric Acid, 5 or 10 per cent.; Salicylic 
Acid, 5 per cent; Chrysarobin, 10 per cent.; Phenol, 5 per 
cent.; Iodoform, 5, 10 and 50 per cent. The only use of py- 
roxylin is for making collodion, which, when painted on the 
skin, quickly forms a thin and dry protective film over it, in 
consequence of the evaporation of the ether. Flexible collodion 
has the advantage over ordinary collodion of not cracking when 
thus dried on the integument. These preparations are pro- 
tective to small wounds and excoriated surfaces, and are used 
after slight operations. The edges of larger wounds may be 
drawn together and kept in position by strips of gauze, which 
are made to adhere to the skin by the application of several 



444 PHARMACOLOGY AND THERAPEUTICS. 

coats of flexible collodion. Collodion is especially serviceable 
for scalp-wounds, in which it often renders a bandage unneces- 
sary. The contraction and compression resulting from the dry- 
ing of the substance are sometimes utilized in the abortive treat- 
ment of boils and styes, and of the papules of small-pox (to 
prevent pitting), as well as in the treatment of epididymitis (in 
which the testicle and cord are freely painted over with it), 
of umbilical hernia, of varicocele, and of spina bifida. Collo- 
dion may also be applied in superficial burns, in erysipelas, and 
in herpes zoster, and, after the parts have been antiseptically 
cleansed with a phenol solution, it often affords relief in 
pruritus ani. The closing of the orifice of the urethra or the 
prepuce with it at bedtime is sometimes successful in putting 
a stop to nocturnal incontinence of urine in male children. Sev- 
eral cases of tuberculous peritonitis have been reported by 
French physicians in which the repeated application of collo- 
dion to the entire surface of the abdomen was followed by 
recovery. 

Action of Cotton Seed Oil. 
Cotton seed oil is nutrient and emollient. 

Therapeutics of Cotton Seed Oil. 
This is used simply as a bland, nutritious oil, and in lini- 
ments. 

OIL OF THEOBROMA. 
OLEUM THEOBROMATIS.— Oil of Theobroma. (Cacao Butter.) 

Action of Oil of Theobroma. 
Oil of theobroma is nutrient and emollient. 

Therapeutics of Oil of Theobroma. 
Oil of theobroma is used to make suppositories, and as a 
source of stearic acid. It is also used by inunction to improve 
the nutrition of the body. Its slight tendency to become oxi- 
dized renders it serviceable for preserving steel instruments 
from corrosion by exposure to the air. 



FLAXSEED. 445 

FLAXSEED. 

LINUM.— Linseed. Flaxseed. 

OLEUM LINL— Linseed Oil. (Flaxseed Oil.) Dose, 30 C.C.; 1 fl. 
oz. 

Preparation. 

Linimentum Calcis. — Lime Liniment. 

Action of Flaxseed. 
Flaxseed is demulcent and emollient. It has been thought 
by some to have expectorant qualities, but it probably has no 
direct action on the bronchial mucous membrane. It is mildly 
diuretic, and its preparations, if given in sufficient amount, have 
a laxative effect. Its diuretic action, it is believed, may be 
due to the excretion by the kidneys of the resinoid oxidation 
products formed from the oil. 

Therapeutics of Flaxseed. 
Externally the meal (lini farina), in the form of poultices 
(4 to io of boiling water with constant stirring and the basin 
being kept hot), is very extensively used for the purpose of 
applying warmth and moisture, especially in inflammatory con- 
ditions, both superficial and deep-seated. It relaxes the tissues 
and relieves pain. It tends to check inflammation if applied 
early, and accelerates the evacuation of pus after suppuration 
has commenced. The poultice, as ordinarily used, however, is 
uncleanly, and has come to be regarded as a hot-bed for bac- 
teria and not infrequently a means of favoring the extension 
of the infectious process present. It has been suggested as a 
good method of preparing poultices to make several bags of 
suitable size, of either of the fabrics known as Swiss and 
cheese cloth, fill them half-full with flaxseed meal, and then 
sew up the open ends. When wanted for use, one of these 
bags is submerged in boiling water for a few minutes (which 
causes the meal to swell so as to fill the bag), and, after the 
superfluous water has been squeezed out, it is laid on the 
affected part and covered with oiled silk and a bandage. Care 



446 PHARMACOLOGY AND THERAPEUTICS. 

should, of course be taken not to apply the poultice so hot as 
to scald the skin. Flaxseed and other poultices not only pro- 
mote local vascular dilatation, but also have a counter-irritant 
effect. Their action may be increased, if desired, by the addi- 
tion of 1 part of mustard to 16 of the material composing the 
poultice, or by smearing the surface to be covered with equal 
parts of belladonna and glycerin, or sprinkling on it a little 
dry mustard or a few drops of turpentine. Laudanum, or lead- 
water and laudanum, may be incorporated in the poultice or 
applied under it if there is much pain or if the skin is broken. 
Poultices are also sometimes medicated with astringents and 
other agents. Linseed oil, made into an emulsion with an equal 
part of lime-water which is popularly known as Carron oil 
(the official Linimentum Calcis), was long a favorite remedy 
for burns, but as it is uncleanly and has a disagreeable odor, it 
has largely been supplanted by other agents. The oil is also 
sometimes used for laxative purposes as an enema, especially 
in children. An infusion of flaxseed, 15 gm. ( x / 2 oz.) to 500 
c.c. (1 pint), is considered an excellent enema in inflammation 
of the rectum, fissure, piles, etc., and is also used as an injection 
in irritations of the bladder and vagina. Flaxseed mucilage, 
prepared by boiling the seed, has been employed to a con- 
siderable extent as an external application in erysipelatous and 
other cutaneous inflammations, burns, etc., but if allowed to 
get dry it renders the skin stiff. Lead acetate is sometimes dis- 
solved in it, precipitating the solution of lead subacetate. Flax- 
seed tea (flaxseed, 3; liquorice, 1; boiling water, 100; infuse 
for two hours) is a common domestic demulcent, which is used 
especially in acute bronchitis and sore throat. If given hot it 
has a diaphoretic effect, and the large amount of mucilage which 
it contains renders it very soothing to the inflamed mucous 
membrane. In the mouth and pharynx it forms a coating 
which is of service in relieving " tickling of the throat " and 
irritative cough. The hot infusion is also used to a considerable 
extent in enteritis and dysentery and in irritation of the stomach 
and the kidneys, cystitis, strangury, etc. It should never be 



olive oil. 447 

boiled during the process of preparing it, as the application 
of too much heat causes the extraction of more or less of the 
oil, and so renders it less palatable. Lemon and sugar may be 
added, according to the taste of the patient, and it may be taken 
ad libitum. Whole flaxseed, in doses of 15 gm. { J / 2 oz.), is 
occasionally used as a laxative in habitual constipation, and the 
oil in doses of 60 c.c. (2 fl. oz.) has been recommended as a 
laxative in the treatment of haemorrhoids. 

OLIVE OIL. 
OLEUM OLIV^E.— Olive Oil. (Sweet Oil.) Dose, 30 C.C.; 1 fl. oz. 

Unofficial Preparation. 
Eunatrol.— Eunatrol. (Sodium Oleate.) Dose, 2 to 5 gm.; 
30 to 80 grs. daily. 

Action of Olive Oil. 
Olive oil is lubricant, emollient, demulcent, nutritive and 
mildly laxative. Externally applied it acts as a protective to the 
skin, which it renders soft and pliant. When rubbed in with suffi- 
cient friction it is absorbed, and afterwards assimilated by the 
system. Taken by the mouth, it is, like other oils, partly emulsi- 
fied and partly saponified in the intestine, and the olein it con- 
tains is finally deposited in the body as fat. If the quantity 
ingested is larger than can be absorbed, the excess will appear 
unchanged in the urine. 

Therapeutics of Olive Oil. 
External. — It is much used to facilitate the rubbing of joints 
and other parts of the body. It is sometimes employed in mas- 
sage, but lanolin and neat's-foot oil are considered the best 
forms of grease for this purpose. Unless the skin is very 
harsh, dry or scaly, however, the manipulation can usually be 
more efficiently performed without any lubricant. Warm olive 
oil is useful for removing crusts in such conditions as sebor- 
rhcea, eczema and psoriasis. It should not be allowed to get 



448 PHARMACOLOGY AND THERAPEUTICS. 

into the eyes, as it is liable to produce considerable irritation 
if it comes in contact with the conjunctiva. It is a common 
soothing protective in burns and acute inflammatory affections 
of the skin, coating the surface and excluding the air. In the 
former it is sometimes used in place of linseed oil in Linimentum 
Calcis (see p. 446). Carbolized oil (1 to 24) often constitutes 
a good dressing for wounds. Olive oil is employed as an emol- 
lient addition to poultices, and with poultices applied in the 
ordinary way it is of service in preventing them from adhering; 
for this purpose it may either be incorporated in the poultice 
or smeared on the surface to which the latter is to be applied. 
As it is absorbed by the lymphatics when rubbed vigorously into 
the skin, it may be used in this way for the purposes of a food 
in cases where sufficient nourishment cannot be taken by the 
mouth. As a nutritive, however, it is less valuable than codliver 
oil, which is administered to a considerable extent by inunction 
in wasting diseases. Oil inunctions are of great service in 
scarlet fever and other exanthematous diseases. They reduce 
temperature and are very grateful to the patient; allaying the 
burning heat and itching of the skin, and in this way diminish- 
ing excitement and restlessness. Their antipyretic effect is also 
probably due to a considerable extent to their influence in 
mitigating one of the chief sources of distress in this class of 
affections. They are especially valuable in the desquamative 
stage of scarlet fever, where they serve a prophylactic purpose 
by preventing the dispersion of the scales in the atmosphere. 
For inunction in fevers carbolized olive oil (1 to 40) is a very 
good preparation, possessing as it does disinfecting properties; 
though cocoa-butter is a more elegant one, and some consider 
benzoated lard the most satisfactory. By dropping a little 
olive oil into the auditory canal insects can readily be removed 
from the ear. The oil was formerly much used as a lubricant 
for catheters, sounds and other instruments, but vaseline has 
here replaced it to a considerable extent. It is employed as an 
ingredient in many liniments, plasters, ointments and cerates, 
but the foreign article is so frequently adulterated with inferior 



olive oil. 449 

oils that cotton-seed oil is now directed in its place in many 
official preparations. A very large proportion of the olive oil 
of commerce at the present day is known to be in reality cotton- 
seed oil, and there appears, indeed, to be no appreciable differ- 
ence between the physiological and therapeutic properties of the 
two, although cotton-seed oil is not so agreeable in flavor. 
Olive oil is a common application in the bites and stings of in- 
sects, and in some parts of Europe and the east it is used both 
locally and internally in the treatment of snake bites. 

Internal. — From ancient times to the present it has been a 
regular article of diet in olive-growing lands, but, except as an 
ingredient of salad-dressings, it is not much used as a food in 
this country. Taken promptly into the stomach in sufficient 
quantity, it is useful in mitigating the effects of irritating 
poisons, but it should not be employed after phosphorus has 
been swallowed, as the latter dissolves in it. As a laxative it 
is much used (in teaspoonful doses) for infants, and it also 
answers very well sometimes in adults. Where the patient does 
not object to its taste it may be advantageously given with 
food. It is especially recommended in the constipation caused 
by opium and as a demulcent laxative in haemorrhoids and fissure 
of the anus. Occasionally it has been successful, when given 
in large doses, in causing the expulsion of tape-worms. On 
account of its blandness it is frequently prescribed in the form 
of an enema, which may be composed entirely of olive oil or of 
oil and warm mucilage of starch in the proportion of 15 to 18. 
The soap enema (soap, 1 ; warm water, 32), however, is the one 
most generally employed for ordinary purposes. Olive oil is 
sometimes injected into the rectum to get rid of thread- worms, 
but is not as reliable as some other agents. It has been found 
very useful in the case of workmen employed in white-lead 
factories in keeping the bowels free and preventing the absorption 
of the metal, and it is also efficient in the treatment of lead colic 
itself. There is now at command abundant clinical evidence of 
the marked value of olive oil in biliary calculi. While out- 
side the body the oil is a solvent for cholesterin, the chief con- 



45 O PHARMACOLOGY AND THERAPEUTICS. 

stituent of gall-stones, it has been doubted by some if when 
taken internally, even in very large amount, it is possible for 
the oil to exert this solvent action. High authorities claim that 
it does assist materially in the solution of calculi ; but whether 
this is the case or not, there can be no question that it is of 
very great service in cholelithiasis by increasing the watery 
secretion of bile. It is recommended that not less than from 
60 to 250 c.c. (2 to 8 fl. oz.) should be taken daily. It may be 
rendered more palatable by the addition of a small quantity of 
menthol and 4 c.c. (1 fl. dr.) of brandy to each 250 c.c. (half- 
pint), or it may be given in aromatized emulsion with a little 
brandy or whiskey. Certain patients can take it better mixed 
with fish, mashed potatoes, or other kinds of food. Some assert 
that the best results may be obtained by giving from 30 to 60 
c.c. (1 to 2 fl. oz.) of olive oil in hot milk for ten nights in 
succession. The remedy is then omitted for a week, and this 
course is kept up for a number of months. In addition to the 
treatment of the gall-stones themselves, sodium benzoate and 
salicylate are recommended as intestinal antiseptics. Eunatrol, 
or pure sodium oleate, is also stimulating to the biliary secre- 
tion and has been found useful in gall-stone disease. From 
2 to 2.40 gm. (30 to 40 gr.) may be taken daily, in .30 gm. 
(5 g r piU s or capsules. Olive oil, in doses increasing from 
15 to 90 c.c. (y 2 to 3 fl. oz.), is said to have caused the dis- 
appearance of obstructive jaundice. In obstinate and painful 
cases of dry pleurisy a small quantity of the oil, sterilized, has 
been injected into the pleural sac with the idea of imitating 
Nature in providing a lubricating fluid. 

OLEIC ACID. 

ACIDUM OLEICUM.— Oleic Acid. 

Action of Oleic Acid. 
Oleic acid is bland and unirritating, and penetrates the skin 
more readily than fats and oils. 



SOAP. 451 

Therapeutics of Oleic Acid. 
It is not employed by itself in medicine, but used pharma- 
ceutically in the preparation of oleates and also in plasters and 
soaps. Oleates, which are readily soluble in fats, and thereby 
rendered more efficient for local application, are made from 
the alkaloids, not from their salts. If metals are employed, 
the oxides only are chosen. The oleates are used for the pur- 
pose of securing the absorption of drugs through the skin. 
Many substances which are either not absorbed at all or only 
to a very limited extent from aqueous, are freely absorbed from 
oily, solutions, while many which are not soluble in oils dissolve 
in oleic acid. Hence the special utility of the oleates. Besides 
the official oleates, a considerable number of others are also 
now in use. Some of them, such as the oleates of copper and 
mercury, are excellent parasiticides, and this class of prepara- 
tions is steadily growing in favor in the treatment of cutaneous 
affections generally, as well as of a variety of other conditions. 

SOAP. 

1. SAPO.— Soap. (White Castile Soap. Hard Soap.) 

Preparations. 

1. Emplastrum Saponis. — Soap Plaster. 

2. Linimentum Saponis. — Soap Liniment. (Opodeldoc.) 

2. SAPO MOLLIS.— Soft Soap. (Green Soap.) 

Preparation. 
Linimentum Saponis Mollis. — Liniment of Soft Soap. (Tinc- 
tura Saponis Viridis.) 

Unofficial Preparation. 
Sapo ' Animalis (B. P.). — Curd Soap. 

Action of Soap. 
Externally soap is detergent and discutient, combining with 
the fat of the excretions and removing, along with this, epi- 



452 PHARMACOLOGY AND THERAPEUTICS. 

thelial scales, bacteria and dirt, or other foreign matter. In- 
ternally it is laxative and antacid. While it softens the epi- 
dermis, it may set up considerable irritation if applied too long 
or with too much friction, or if the soap used is too strongly 
alkaline or not sufficiently diluted with water. 

Therapeutics of Soap. 
In modern surgery it is customary to scrub the part to be 
operated upon with hard soap and water before washing it 
with an antiseptic solution. Good Castile soap is considered the 
best representative of a pure soap to be had. Hard soap, in 
powder, is used to some extent as an ingredient of dentifrices, 
and it no doubt aids in the preservation of the teeth. In recent 
years it has been considerably employed for medicated soaps, 
which, if judiciously applied, are decidedly beneficial in a 
variety of cutaneous affections. Among the agents commonly 
incorporated in them are sulphur, tar, phenol, mercuric bi- 
chloride, ichthyol, eucalyptol, naphthol and salicylic acid. In 
ordering a medicated soap the desired percentage of the drug 
to be used should be given in the prescription. Soaps are 
ordinarily used for cleansing. Most toilet soaps, it has been 
pointed out, are too strongly alkaline and often contain irritating 
essential oils; while many cheap kinds are made with animal 
fat which has not been properly purified, and therefore liable 
to contain the bacteria of putrefaction and possibly of disease. 
In the case of persons with delicate skins, and especially in- 
fants, it is very important that only a bland and pure article 
should be selected. A carefully prepared glycerin soap is be- 
lieved to be, on the whole, the best for the skin. Soap mixed 
with brown sugar has long been a favorite domestic remedy 
in the local treatment of boils. It makes a useful stimulating 
dressing, and, if applied sufficiently early, appears to mitigate 
the pain as well as quicken suppuration. Soap suppositories 
inserted in the rectum generally cause a prompt evacuation of 
the bowels, and are frequently resorted to in the constipation 
of infants. For use in adults, particularly, their efficiency may 



soap. 453 

be increased by the addition of glycerin. Hard soap is a good 
excipient for pills, and it forms the basis of several of those in 
the Pharmacopoeia. Soap is of considerable value as an anti- 
dote in poisoning by acids and other irritants. It also acts as 
an aid to emetics, and has the great advantage of being always 
accessible. In such cases its use should be resorted to at the 
earliest possible moment and continued until more powerful 
alkalies, such as chalk, magnesia, or sodium bicarbonate, can be 
obtained. A teacupful of solution of soap, in the proportion of 
about one to four, by weight, of water, may be repeated at short 
intervals until the patient has taken all that he can swallow. 
If promptly applied, soapsuds are also an excellent remedy for 
external burns by acids and by phosphorus. Soap was formerly 
used to some extent in dyspepsia attended with inactivity of 
the liver and constipation, and is still occasionally employed in 
acidity of the stomach, as it is readily decomposed by very 
weak acids, which combine with the alkali. Even as an antacid, 
however, it has been largely supplanted by other agents, and 
it is very rarely given internally at all except in combina- 
tion with other agents in pills. By its alkaline properties 
it may afford more or less relief in cystitis, but the claim 
once made for it that it is a solvent for vesical calculi 
has long since been disproved. Soap plaster is protective 
against bed-sores, and is also sometimes used as a support 
about sprained joints. Linimentum Saponis is a cutaneous 
stimulant. It is employed with friction in sprains, stiffness of 
the joints or muscles, etc., and it constitutes the basis of the 
official chloroform liniment. It is also a favorite basis for ex- 
temporaneous liniment prescriptions, and such agents as aconite, 
opium and belladonna are frequently combined with it. 

Soft soap, which is also known as green soap, although it is 
not generally green, but of a brownish color, is much more 
strongly alkaline than hard, and, containing free potassium 
hydroxide, as it does, is decidedly irritant. It has a soft- 
ening effect on tissues with which it comes in contact, 
and is therefore of considerable service in chronic indur- 



454 PHARMACOLOGY AND THERAPEUTICS. 

ations of the skin. One of its uses is to remove crusts 
and epithelial scales in cutaneous affections. It is also of 
value in the general treatment of a number of diseases of 
the skin, and among the more prominent of those in which 
it has proved of service are chronic psoriasis, acne, tinea, and 
even lupus. If there is much itching, it may be combined with 
oil of cade. For chronic eczema it has been found that the 
best form in which to use it is the Linimentum Saponis Mollis, 
which should be well rubbed into the affected part and fol- 
lowed by a soothing application, such as simple cerate. The 
liniment is an excellent cleansing agent for the scalp, especially 
in seborrhoea, and for shampooing purposes it should be diluted 
with three parts of alcohol or Cologne water. When pediculi are 
present it is useful in preparing the way for a parasiticide appli- 
cation by dissolving the adhesion of the nits to the hair shafts. 
This, like the Linimentum Saponis, is also employed as an appli- 
cation, usually enforced by more energetic medicinal agents, 
for sprains, stiff joints, etc. Soft soap is furthermore used 
locally in the treatment of enlarged glands, whether the con- 
dition is a simple inflammatory one or of strumous or syphilitic 
origin. Its external application may be of some service, as well, 
in other strumous or tuberculous conditions, such as disease 
of the mesenteric glands or periostitis, and in exudations into 
serous cavities. One of the most common uses of both hard 
and soft soap is for purgative enemata; but the latter is de- 
cidedly preferable. For this purpose either may be made into 
a lather with 500 c.c. (1 pint) or more of water at a tempera- 
ture of 37.8 C. (ioo° F.). Soap enemata are somewhat liable 
to give rise to an erythematous or urticarial eruption, and this 
appears to be especially the case with those made with hard 
soap. In some individuals such a rash makes its appearance 
regularly after each injection, however often the enema may 
be repeated. This may be due to some irritant in the soap em- 
ployed, or possibly, as some are inclined to believe, may result 
from the solution and consequent absorption of some fsecal 
toxin. Doubt has been expressed whether the rectal injection 



raisins. 455 

of soap and water has any more effect in causing an evacuation 
of the bowels than would an enema of warm water alone or the 
same quantity of thin oatmeal gruel; but it seems altogether 
probable that the soap itself has some purgative action, though 
this may sometimes be but slight. In order to increase the effi- 
ciency of a soap enema it may be advisable to add to it a cer- 
tain amount of castor oil. The quantity of soft soap used is 
usually about 30 c.c. (1 fl. oz.). In some hospitals there is 
employed an enema, known as the " House Mixture," which 
consists of soft soap, molasses and water in varying proportions, 
and to which turpentine and olive oil are added if flatulence be 
present. This, it is claimed, is " as efficient as it is cheap and 
dirty." 

Sapo Animalis, or curd soap, consists chiefly of sodium 
stearate, and, like other soaps, it is detergent. Its solution 
in boiling alcohol, after cooling, forms a jelly-like mass which 
constitutes the basis of hard opodeldoc. Curd soap is also used 
as a basis for plasters, liniments, pills and suppositories. Em- 
plastrum Saponis Fuscum (brown soap plaster, not official) is 
curd soap, 20 ; yellow wax, 25 : olive oil, 40 : lead oxide, 30 ; 
vinegar, 320. 

RAISINS. 

JJYJE. — Raisins (not official). 

Action of Raisixs. 

Raisins are demulcent and nutritive. Taken in bulk, they 
are slightly laxative, but are difficult of digestion and liable to 
produce flatulence. The fresh pulp has some diuretic action, 
which is attributed in great part to the grape-sugar which it 
contains. 

Therapeutics of Raisixs. 

Raisins are used as sweetening and flavoring agents, especially 
in demulcent and amylaceous beverages, such as the infusions 
of flaxseed, rice, oatmeal and barlev. 



45^ PHARMACOLOGY AND THERAPEUTICS. 

SOJA BEAN. 
SOJA HISPIDA.— Soja Bean (not official). 

Action of Soja Bean. 
Soja bean is demulcent and nutritive. In southern Asia it is 
used as a food, and the plant is also cultivated for the purpose 
of preparing from it a sauce called soy. 

Therapeutics of Soja Bean. 
In the dietetic treatment of diabetes it is used, in the form of 
bread and biscuits made from the flour, as a substitute for 
gluten bread. Many patients prefer the taste of these to that 
of the latter, and they have been found quite as efficacious in 
reducing the amount of sugar passed in the urine. 

MALT. 
MALTUM.— Malt. (Byne.) 

Preparation. 
Extractum Malti. — Extract of Malt. Dose, 16 c.c; 4 fl. dr. 

Unofficial Preparation. 
Taka-diastasum. — Taka-diastase. Dose, 0.30 to 0.60 gm.; 
5 to 10 gr. 

Action of Malt. 
Malt is demulcent and nutritive. Many of the malt extracts 
manufactured are quite inert as regards the digestion of starch, 
inasmuch as the diastase of the malt has been destroyed by the 
heat employed in their preparation; but, while thus devoid of 
digestive power, they form a pleasant, easily digested food. 
Alcohol, as well as heat, destroys the ferment, and the liquid 
malts containing alcohol are also worthless for assisting starch 
digestion. Many are only beers of an inferior quality, and the 
best of them are indistinguishable from stout. True extract of 
malt contains no alcohol at all. Taka-diastase, which is named 



MALT. 457 

after its discoverer, Takamine, and is an enzyme derived from 
Enrotium oryza, a fungus of the aspergillus family, has been 
found to be very much more energetic than any of the malt 
extracts, as it digests over one hundred times its own weight 
of starch. As soon as the acidity of the gastric juice exceeds 
o.i per cent, it ceases to act in it, but it is able, no doubt, to 
digest a considerable amount of starch in the mouth and 
stomach before it is destroyed. It is a question of great prac- 
tical interest, however, whether the ordinary digestive juices 
are ever unable to digest the starch of the food, and it may be 
stated, on high authority, that no satisfactory evidence of the 
existence of a supposed class of cases to which the name of 
amylaceous dyspepsia has been given has as yet ever been 
brought forward. Until it is shown that in some instances the 
digestion of starch by the intestinal ferments is insufficiently 
performed, the diastase preparations would seem, therefore, to 
be superfluous. As the opinion is very widely held, however, 
that in many cases the natural ferments do fail to adequately 
perform this function, and that in them diastase to some extent 
supplies their place, it appears to be the part of wisdom, for 
the present at least, to give the latter the benefit of the doubt. 
All malts, consequently, should be rejected which do not con- 
tain at least 4 per cent, of diastase. Maltose, which is a prod- 
uct of the action of the ferment diastase upon starch, leads to 
the formation of fat and constitutes, in many conditions, a very 
excellent food. Its value in this respect rests on the fact that 
it is readily absorbed both in the stomach and small intestine. 
In the system it undergoes a transformation into dextrose, and 
it is not found present as maltose in the tissues. As the malt 
liquors contain malt extract, as well as hops, an aromatic 
bitter, their nutritive, tonic and stomachic qualities are greater 
than those of spirits and wine. At the same time, it must not 
be forgotten that the beneficial effects of these constituents are 
to a very considerable extent diminished by the process of fer- 
mentation; so that the value of such beverages as foods is apt 
to be greatly exaggerated by their habitual consumers. They in- 



45 8 PHARMACOLOGY AND THERAPEUTICS. 

crease the appetite and lead to the deposition of fat, and when 
taken in excess are not infrequently the cause of fatty degenera- 
tion in various organs, more particularly the liver and the 
heart. 

Therapeutics of Malt. 
Malt extracts, the value of which depends principally on the 
amount of maltose they contain, are used in all conditions where 
it is desirable to give a readily assimilable carbohydrate food. 
They are particularly indicated in convalescence from acute 
disorders, in the derangements of the system caused by chronic 
disease, and in cases of wasting and of poor digestion and 
assimilation. They are usually well borne by the stomach, 
and in many instances can be taken by those who reject other 
nutritive agents, such as codliver oil. While not possessing 
all the virtues of the latter in pulmonary tuberculosis, they 
sometimes prove a satisfactory substitute for it. Not infre- 
quently extract of malt is advantageously combined, in emul- 
sion, with codliver oil; the comparatively small dose of the 
latter then required being less apt to disagree with the patient 
than a larger quantity taken by itself. Such emulsions should 
contain about I part of oil to 4 of malt. Malt extracts are very 
largely given for the purpose of assisting the digestion of 
starchy foods. Diastase, it should be remembered, like the fer- 
ments of the saliva and pancreatic fluid, can act only in a 
neutral or alkaline medium. As experiments have demonstrated 
that this agent, when taken into the stomach, must sooner or 
later be completely destroyed by the gastric juice, it has been 
advised that when the diastatic action of malt extract is de- 
sired, it should always be given at the beginning of a meal. 
Usually, however, it is directed to be taken at least two hours 
after a meal, by which time the stomach is presumed to be 
free from the acid gastric juice. By some authorities it is be- 
lieved that in most cases the administration of diastatic ferments 
is of little benefit, and that the great value attached to them 
rests on the fact that they are useful agents in producing pre- 
digested foods. Malt extract may be used to form a syrupy 



sugar. 459 

mixture with preparations of iron or cinchona. The follow- 
ing will often be found serviceable : Ferric pyrophosphate, 2 ; 
water, 3; dissolve and add extract of malt, 95. Dose, 4 to 15 
c.c. (1 to 4 fl. dr.). Malt extract, to which a suitable amount 
of fluidextract of cascara sagrada has been added, is an ex- 
cellent laxative. 

PEARL BARLEY. 

HORDEUM DECORTICATUM.— Pearl Barley (not official). 

Action of Pearl Barley. 
Barley, the best form of which for medicinal use is pearl 
barley, is demulcent and highly nutritious. It contains rather 
more proteid than wheat, and is rich in phosphates and iron. It 
constituted the principal diet on which the Grecian athletes were 
trained. It is one of the blandest and least irritating of fari- 
naceous substances, and is an excellent antiscorbutic. 

Therapeutics of Pearl Barley. 
Barley water (1 to 15 of boiling water) forms a pleasant 
demulcent drink, especially if the throat be dry and inflamed. It 
is the most ancient of fever beverages, and its efficiency in sore 
throat and bronchial affections may be increased by the addi- 
tion of honey. It is used to a considerable extent in various 
inflammatory conditions, especially when the mucous membrane 
of the stomach or the urinary tract is involved. It is also 
given for the diarrhoeas of infants, and its addition to the milk 
of all bottle-fed children has been recommended. For ordi- 
nary use it may be sweetened and flavored with lemon. 

SUGAR. 

SACCHARUM.— Sugar. (Cane Sugar. Sucrose.) 

Preparation. 
Syilipus. — Syrup. 

Unofficial Preparation. 
Levulosum.— Levulose. (Fruit Sugar. Diabetin.) 



460 PHARMACOLOGY AND THERAPEUTICS. 

Action of Sugar. 

Sugar is nutrient, demulcent and antiseptic. It is an anti- 
putrefactive, but not an antifermentative. While essentially a 
food, it contains no nitrogen, and is therefore incapable of sus- 
taining life by itself. It is a hydrocarbon, and in the system 
develops adipose tissue and acts as a respiratory fuel. In the 
healthy individual sugar and sugar-forming food, it is estimated, 
constitute more than one-half of the nourishment required by 
the body. It also has some diuretic action. Eaten freely, it is 
said to interfere with the development of alcoholic intoxication, 
an effect which has been attributed to its retarding gastric 
absorption. 

Therapeutics of Sugar. 

Sugar is used as a sweetening and preservative agent. Syrup 
is used as a vehicle. Syrupus Glucosi (B. P., not official). 
Syrup, 2; liquid glucose of commerce, 1, is used in pharmacy, 
especially in the making of pills, as it forms a neutral basis. 
Sugar is the principal basis of troches, gum pastilles, and 
various other preparations. Mixed with iron preparations, it is 
a protective against oxidation. On account of its attraction 
for water, powdered or granulated sugar, locally applied, makes 
a good styptic (which is also antiseptic), in cases of emergency. 
White sugar does not seem to have any aperient effect, but 
molasses and imperfectly refined sugar intensify intestinal 
action and are considerably used in domestic medicine as mild 
laxatives. When taken in moderation sugar tends to promote 
digestion and allay nervous excitement, and sweetened water 
(cau sucree) is very extensively used for such purposes in 
France and other parts of Europe. In catarrhal affections of 
the air-passages sugar has a soothing effect upon the mucous 
membrane, and the vapor of boiling cane-juice is stated to have 
proved of great value in bronchitis and even pulmonary tuber- 
culosis. Finely powdered lump sugar may relieve the hiccough 
of nursing infants which arises from over-feeding, and lump 
sugar is a common domestic remedy for hiccough in general. 
The chemical compound which sugar forms with lime, calcium 



LIQUORICE. 461 

saccharate (Syrupus Calcis, U. S. P.), is said to be an anti- 
dote to phenol. Sugar is contraindicated in diabetes mellitus, 
obesity, and conditions involving fermentative changes in the 
stomach or intestines. Levulose, a fruit-sugar sold under the 
trade-name of Diabctin, is now extensively used as a food and 
substitute for cane-sugar in cases of diabetes. It is well assimi- 
lated in the disease, a small proportion only being excreted in 
the urine, and is regarded as having the same nutrient value as 
cane-sugar. 

LIQUORICE. 

GLYCYRRHIZA.— Glycyrrhiza. Liquorice Root. Dose, 2 gm.; 
30 gr. 

Preparations. 

1. Extractum Glycyrrhizse. — Extract of Glycyrrhiza. (Ex- 
tract of Liquorice.) Dose, 1 gm.; 15 gr. 

2. Extractum Glycyrrhizse Purum. — Pure Extract of Gly- 
cyrrhiza. Dose, 1 gm.; 15 gr. 

3. Fluidextractum Glycyrrhizse. — Fluidextract of Glycyr- 
rhiza. Dose, 2 c.c; 30 trt- 

4. Elixir Adjuvans. — Adjuvant Elixir. 

5. Glycyrrhizinum Ammoniatum. — Ammoniated Glycyrrhizin. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

6. Mistura Glycyrrhizse Composita. — Compound Mixture of 
Glycyrrhiza. (Brown Mixture.) Dose, 8 C.C.; 2 fl. dr. 

7. Pulvis Glycyrrhizse Compositus. — Compound Powder of 
Glycyrrhiza. Dose, 4 gm.; 60 gr. 

8. Pilulse Laxativse Compositse. — Compound Laxative Pills. 
Dose, 2 pills. 

Action of Liquorice. 
Liquorice is demulcent, expectorant and laxative. Locally it 
has a slightly stimulating action, and it increases the flow of 
saliva and mucus when slowly chewed or sucked. 

Therapeutics of Liquorice. 
In sore throat and bronchitis liquorice is an excellent de- 
mulcent. The hardened extract is a popular remedy for tickling 



462 PHARMACOLOGY AND THERAPEUTICS. 

cough and hoarseness, and Brown Mixture is much used in 
dispensary practice as an expectorant. Liquorice is largely 
employed to conceal the taste of disagreeable medicines and as 
a basis for pills. The root is commonly used as a dusting- 
powder and coating for the latter. The compound liquorice 
powder is a pleasant and efficient laxative, and is especially well 
adapted for pregnant women and children. When necessary, 
it may be advantageously combined with an equal quantity of 
compound jalap powder. The demulcent properties of liquorice 
render it serviceable in irritable conditions of the mucous mem- 
brane of the bladder and intestines, as well as of the air-pas- 
sages. It may also be given with flaxseed tea or barley water 
in various febrile affections. Ammoniated glycyrrhizin pos- 
sesses no advantage over the extract, and is devoid of the 
demulcent properties of the drug. 

SLIPPERY ELM BARK. 
ULMUS.— Elm. (Slippery Elm Bark.) 

Preparation. 
Mucilago Ulmi. — Mucilage of Elm. Dose, 16 c.c; 4 fl. dr. 

Action of Slippery Elm Bark. 
Slippery elm bark is highly demulcent and in some degree 
tonic and nutritive, as well as slightly astringent. 

Therapeutics of Slippery Elm Bark. 
Slippery elm bark is an excellent demulcent, and is especially 
recommended in dysentery, diarrhoea and diseases of the urinary 
passages. It is often employed to make poultices, especially for 
use upon children, because it is lighter than flaxseed. The 
poultices, with lead water, are serviceable in erysipelas and 
various forms of local inflammation ; they may be applied either 
hot or cold. The bark is also used in the dilatation of fistulae, 
strictures and the os uteri, and, in conjunction with various 
medicinal extracts, in the formation of rectal and vaginal sup- 



ACACIA. 463 

positories. When chewed it moistens the mouth and throat, and 
employed in this way it is soothing in irritable conditions of 
the faucial and bronchial mucous membrane. It is stated to 
have sometimes proved successful in the treatment of tape- 
worm. 

ACACIA. 

ACACIA. — Acacia. (Gum Arabic) 

Preparations. 

1. Mucilago Acacise. — Mucilage of Acacia. Dose, 16 c.c; 4 
fl. dr. 

2. Syrupus Acacise. — Syrup of Acacia. 

Action of Acacia. 
Acacia is a valuable demulcent. It has been experimented 
with as a food, but appears to have little or no nutrient quality, 
though it may possibly retard tissue-waste and in this way 
prove capable of prolonging life. 

Therapeutics of Acacia. 
On account of its demulcent properties it is employed at times 
in inflammatory conditions of the bronchial, gastric, vesical 
and intestinal mucous membrane, in which it acts as a local 
palliative. One part dissolved in 30 of water and flavored with 
syrup of lemon, or otherwise, makes a pleasant and serviceable 
beverage. Acacia is also useful as a vehicle for more powerful 
remedies. As a protective to the inflamed surfaces in pharyn- 
gitis, laryngitis, etc., it is commonly used in the form of lozenges, 
in which astringents or other agents may be incorporated in ac- 
cordance with the indications present. To loosen hacking coughs 
it is largely employed with flaxseed in the form of a mucilage, 
flavored with lemon-juice and sweetened, to which liquorice 
is generally added. Mucilage of acacia may sometimes be of 
service in cases of irritant poisoning. One of the chief uses 
of acacia is to emulsify oils and resins. 30 c.c. (1 fl. oz.) of 
most oils or resinous tinctures require 12 c.c. (3 fl. dr.) of 



464 PHARMACOLOGY AND THERAPEUTICS. 

mucilage of acacia for suspension, but copaiba requires 40 c.c. 
(10 fl. dr.). The tendency of the mucilage to undergo acetous 
fermentation, which greatly interferes with its emulsifying 
capacity, may be overcome to some extent by making it with 
tolu or clove water. For the suspension of insoluble powders 
it is not so satisfactory as tragacanth, as it is liable to form 
cements which are difficult to disperse. Externally, acacia has 
a certain amount of utility. Its thick mucilage, to which some 
antiseptic should be added, may be employed as a protective for 
superficial burns, excoriations and ulcers. Powdered acacia 
is sometimes used to arrest bleeding from leech bites and other 
sources of slight haemorrhage. Mixed with one-half its quan- 
tity of powdered arrow-root and one-quarter of borax, together 
with a small amount of camphor, it is serviceable, dusted over 
the surface, for sore nipples. An ointment made with 24 gm. 
(6 dr.) of powdered acacia and 4 gm. (1 dr.) of oleate of zinc 
to 30 gm. (1 oz.) of lanolin, is also a good application in this 
affection, as well as in some diseases of the skin. A snuff com- 
posed of acacia and bismuth subnitrate, to which a little mor- 
phine may be added, is often useful in checking coryza. 

TRAGACANTH. 

TRAGACANTHA.— Tragacanth. 

Preparation. 
Mucilago Tragacanthse. — Mucilage of Tragacanth. Dose, 16 
c.c; 4 fl. dr. 

Unofficial Preparation. 
Bassorinum. — Bassorin. 

Action of Tragacanth. 
Tragacanth is demulcent and slightly nutritive. If given in 
large quantity it is apt to cause indigestion, unless accompanied 
by some antiseptic agent, like creosote or naphtol, in order to 
prevent fermentation. 

Therapeutics of Tragacanth. 
Its chief use is to suspend insoluble powders. The mucilage 



ALMOND. 465 

is better for this purpose than the compound powder (B. P., 
not official), tragacanth, 1; acacia, 1; starch, 1; sugar, 3; 
which, because of its starch, is liable to ferment. More- 
over, acacia is contra-indicated when tragacanth is employed 
as a suspending agent. Tragacanth is less useful than acacia 
as an emulsifying agent for resins and oils, for the reason that 
it is almost insoluble in water. Glycerin of tragacanth (B. P.) 
is sometimes employed as a pill excipient, but is apt to render 
the pills hygroscopic, and glucanth is more generally useful for 
this purpose. It is composed of tragacanth, 1 ; glycerin, 1 ; 
water, 1 ; commercial syrupy glucose, 7. Tragacanth is some- 
times used as a vehicle for medicinal agents in gargles, and 
is a constituent of most of the official troches. It may be em- 
ployed as a demulcent in pharyngitis, gastritis and intestinal 
inflammation. On account of its greater tenacity, its mucilage 
may sometimes be preferable to that of acacia as an external 
protective. Bassorin (found in India gum and in salep) has 
been used as a base for the application of cutaneous medica- 
ments. 

ALMOND. 

1. AMYGDALA AMARA.- Bitter Almond. 

2. OLEUM AMYGDALA AMAE5I.- Oil of Bitter Almond. 
Dose, 0.03 c.c; y 2 n\. 

Preparations. 

1. Aqua Amygdalae Amarae. — Bitter Almond Water. Dose, 
4 c.c; 1 fl. dr. 

2. Spiritus Amygdalae Amarae.— Spirit of Bitter Almond. 
(Essence of Bitter Almond.) Dose, 0.5 C.C.; 8 Tl\. 



in.. 



4. AMYGDALA DULCTS.— Sweet Almond. (Jordan Almond.) 



Preparations. 

1. Emulsum Amygdalae. — Emulsion of Almond. (Milk of 
Almond.) Dose, 120 c.c.; 4 fl. oz. 

2. Syrupus Amygdalae.— Syrup of Almond. Dose, 4 c.c; 1 
fl. dr. 



31 



466 PHARMACOLOGY AND THERAPEUTICS. 

5. OLEUM AMYGDALA EXPRESSUM.— Expressed Oil of Al- 
mond. Dose, 30 c.c; 1 fl. oz. 

Unofficial Preparation of Almond. 
Kesorbinum. — Resorbin. 

Action of Almond. 
The sweet almond is demulcent and nutritive. Bitter almond, 
which differs from it in containing amygdalin, is poisonous in 
large quantities. 

Therapeutics of Almond. 
The official emulsion, formed by triturating sweet almonds 
with water, is a soothing and emollient drink which may prove 
of service in irritations of the pharynx and air-passages, as 
well as of the stomach and intestines. It is also a pleasant 
vehicle for other remedies in various conditions, and is espe- 
cially useful for insoluble drugs. The emulsion of bitter 
almond (not official), in teaspoonful doses, is used for the same 
purposes, and particularly as a vehicle for expectorant medi- 
cines. Both emulsions are employed to some extent as a vehicle 
in gonorrhoea, as they serve to relieve ardor urinse. The com- 
pound powder of almonds, B. P. (sweet almond, 8; sugar, 4; 
acacia, 1) is a palatable basis for powders. The expressed oil 
of almond might be used for the same purposes as olive oil, 
but is more expensive. To most persons it is much more 
palatable than the latter. This oil is used to a considerable 
extent in ointments, producing a whiter preparation than olive 
oil, and is especially useful as an application to the hair. It 
is serviceable for excoriations, chapped hands, and inflamma- 
tory affections of the skin, and also as a local application in 
earache. Internally it may be used as a laxative. One of 
the most important medicinal uses of the sweet almond 
is in the form of bread and biscuits made from almond 
flour. They contain practically no starch, and, being pal- 
atable and nutritious, have proved a very satisfactory sub- 
stitute for the various preparations of wheat flour in the diet 



GLYCERIN. 467 

of diabetics. They are expensive, but with a little care may- 
be made at home; thus reducing the cost to the minimum. 
Almond meal is sometimes used instead of soap for the toilet, 
rendering the skin soft and smooth. Resorbin, made by emulsi- 
fying expressed oil of almond with distilled water and yellow 
wax, gelatin and soap, with the addition of a small quantity of 
lanolin, is a good vehicle for active drugs in the medication 
of the skin, and will, it is said, promote the cutaneous absorp- 
tion of mercury. It has been employed in the treatment of 
ichthyosis, pityriasis, scleroderma, prurigo, seborrhceic eczema, 
and other affections. Sweet almond emulsion, combined with 
bismuth subnitrate and thymol iodide, or with ammonium chlo- 
ride and mercuric bichloride, may be used locally for the re- 
moval of sunburn, freckles and skin pigmentations. With mer- 
curic bichloride alone it is recommended in acne rosacea. As a 
substitute for cherry-laurel water, which is considerably used in 
Europe as a sedative narcotic and which owes its effects to the 
prussic acid which it contains, but which is objectionable from 
its unequal strength, it has been proposed to employ an extem- 
poraneous mixture of amygdalin with emulsion of sweet almond. 

GLYCEKIN. 

GLYCERINUM.— Glycerin. Glycerol. Dose, 4 C.C.; 1 fl. dr. 

Preparations. 

1. Glyceritum Amyli. — Glycerite of Starch. 

2. Glyceritum Phenolis. — Glycerite of Phenol. (Glycerite of 
Carbolic Acid.) Dose, 0.3 c.c; 5 n\,. 

3. Glyceritum Acidi Tannici. — Glycerite of Tannic Acid. 
Dose, 2 c.c; 30 lit. 

4. Glyceritum Boroglycerini. — Glycerite of Boroglycerin. 

5. Glyceritum Hydrastis.— Glycerite of Hydrastis. Dose, 2 
c.c; 30 TTt- 

6. Glyceritum Ferri, Quininae et Strychnine Phosphatum. 

— Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 c.c; 15 TTt. 



468 PHARMACOLOGY AND THERAPEUTICS. 

7. Suppositoria Glycerini. — Suppositories of Glycerin. 

8. Gelatinum Glycerinatum.— Glycerinated Gelatin. 

Unofficial Preparations. 
Glyceritum Vitelli (U. S. P., 1890).— Glycerite of Yolk of 
Egg. Dose, freely. 

Glycerinum Boracis (B. P.). — Glycerin (or Glycerite) of 
Borax. 

Mel Boracis (B. P.). — Borax Honey. 

Action of Glycerin. 

External. — Glycerin is powerfully hygroscopic. Applied to 
the cutaneous surface, it is somewhat irritant, and even when 
diluted causes a temporary smarting in cuts and abrasions. 
This local irritation is attributable to its great avidity for 
water, in consequence of which it tends to abstract the fluids 
from the tissues. The pain quickly subsides, however, and it 
then acts as a protective to the parts. In its completed action, 
especially when diluted, it is emollient and demulcent to the 
skin and to mucous membranes. When injected into the rec- 
tum, however, it causes, by its irritant action, peristalsis and 
evacuation of the bowels. 

Internal. — In animals large doses of glycerin, injected sub- 
cutaneously, cause death in periods varying from one hour to 
several days according to the amount administered. The symp- 
toms noted are restlessness, acceleration of the heart and re- 
spiration, dryness of the mucous membrane, with marked thirst, 
loss of muscular power, vomiting, bloody urine, fall of tem- 
perature, convulsions, somnolence, coma, and death from failure 
of the respiration. The larger the dose, the more pronounced 
the convulsions, which are tetanic in character. In such cases 
the fall of temperature is preceded by a considerable rise, while 
in the more prolonged cases (in which the dose is not ex- 
cessive), the fall may or may not be preceded by a rise, and 
does not usually occur until quite late in the poisoning. The 
principal change found post mortem is intense pulmonary, renal 



GLYCERIN. 469 

and intestinal congestion, with more or less softening of the 
tissue. Glomerulo-nephritis has sometimes been observed. The 
haemoglobin which appears in the urine when glycerin is sub- 
cutaneously injected in large quantities is due to the destruction 
of the red blood-corpuscles ; although when glycerin is added 
to the drawn blood it does not act as powerfully on it as many 
other agents which produce no haemoglobinuria. The latter 
effect after its subcutaneous injection has been explained on 
the hypothesis that the glycerin remains outside the vessels 
for some time, and withdraws the fluid from the red corpuscles 
as they pass through the poisoned zone. When, however, glyc- 
erin is injected into the blood, it diffuses rapidly throughout the 
body, and the blood-cells are less acted on by the diluted poison. 
Accordingly, it is found that haemoglobin scarcely ever appears 
in the urine after intravenous injection, although this is occa- 
sionally noted when glycerin is given in large doses by the 
mouth. The violent convulsions caused by it would seem to 
indicate that glycerin acts directly on the central nervous sys- 
tem. Notwithstanding the fact that in animals it destroys life 
in a few hours, in man very large doses of glycerin, taken by 
the mouth, ordinarily produce only a mild gastro-intestinal 
irritation. In the case of a man who was accustomed to take 
90 c.c. (3 fl. oz.) daily it is said, however, to have caused ex- 
treme cerebral excitement. Glycerin is rapidly absorbed from 
the intestine and undergoes oxidation in the tissues; only a 
very small fraction of it appearing in the urine. Like alcohol, 
which is also readily absorbed, it therefore acts in some sense 
as a food, and serves to increase the total energy of the body. 
Glycerin, it has been pointed out, tends to increase the non- 
nitrogenous, and not the nitrogenous reserve of the body, its 
combustion saving a certain amount of the fat from being de- 
stroyed. It is, therefore, of only secondary importance as a 
food, although, like alcohol, it may be of value in certain con- 
ditions. As in the case of the latter, it is still regarded as un- 
decided how far it leads to an economy of the nitrogenous 
tissues, as the fats and carbohydrates do. Internally, as 



470 PHARMACOLOGY AND THERAPEUTICS. 

well as externally, glycerin is a good demulcent, but, since 
it is so quickly absorbed, its action does not extend be- 
yond the stomach. It has been claimed by some authors 
that its administration at times occasions the appearance 
in the urine of a substance which reduces cupric oxide 
and gives the fermentation test for sugar, but this is 
stated not to have been confirmed on more careful in- 
vestigation. In some forms of experimental glycosuria glyc- 
erin appears to reduce the amount of sugar present, and it is 
believed that it probably has some effect on the sugar formation 
in the tissues, although no satisfactory explanation of its action 
in this particular has as yet been given. It has been demon- 
strated to have decided value as an antiseptic, and this is 
thought to be due to its well-known hygroscopic properties, in 
consequence of which water is withdrawn from the microbes. 
It is destructive to parasites, both intestinal and external. 

Therapeutics of Glycerin. 
External. — Glycerin is employed to a considerably greater 
extent externally than as an internal remedy. It is an ex- 
tremely useful emollient, and as it does not evaporate or turn 
rancid, and is readily absorbed when rubbed into the skin, it 
has many advantages as a vehicle for the application of active 
medicinal agents. Applied to the mucous membrane by means 
of a camel's hair brush, pure glycerin affords much relief in 
acute coryza. Glycerin, diluted one-half with distilled water, 
or the glycerin of borax (B. P.) is of great service in reliev- 
ing the dryness of the lips, mouth and tongue in fevers, and 
the latter preparation, as well as the honey of borax (B. P.), 
in which glycerin is an ingredient, is also used as a demulcent 
and sedative to the mucous membrane of the mouth and 
pharynx. A solution of morphine in glycerin is sometimes ap- 
plied with a brush to the fauces to allay the irritating cough 
of phthisis. A mixture of glycerin, crystallized sugar, and 
whiskey, which is allowed to trickle down the throat, may also 
be given for the same purpose. Among the many other useful 



GLYCERIN. 47 1 

applications of glycerin are the following: For chapped face 
and hands, sore nipples, and piles it may be combined with 
witchhazel water and rose water; for excoriations, erythema, 
and superficial burns, with lime water and rose water; for 
erythematous or vesicular eczema, burns, and seborrhcea, espe- 
cially about the axilla and the genital organs, with carbolic acid, 
witchhazel water, and either bismuth subnitrate or sodium 
bicarbonate; for freckles and other skin pigmentations with 
lactic acid and rose water, and for pruritus, eczema and urti- 
caria with creosote and oil of peppermint. The latter combina- 
tion may also be used, in the form of a spray, in nasal catarrh, 
pharyngitis and laryngitis. The glycerite of tannin makes an 
excellent astringent application for sore throat (particularly 
chronic follicular pharyngitis), relaxed mucous membranes, and 
other conditions, and it is said that the daily topical use of 
glycerin is capable of causing a steady reduction in the size 
of hypertrophied tonsils. The glycerite of starch is frequently 
employed as a vehicle for the application of astringents to the 
eye, and glycerin and its preparations are also much used in 
ear affections. Glycerized collodion (glycerin, 2; collodion, 
100), which is extremely supple and does not crack and scale 
off from the skin, is less painful than pure collodion, and forms 
a serviceable protective for fissures and abrasions. For fissured 
nipples a liniment composed of one part of tincture of benzoin 
to six or eight of glycerin is also highly recommended. Glyc- 
erin is a convenient vehicle for the absorption of drugs by the 
skin, and one of the most common applications of this use is 
in the case of belladonna, the local anodyne action of which 
may be obtained by rubbing it in mixed with glycerin. Glyc- 
erin, either alone or combined with an astringent or sedative, 
may be employed for the prevention of bed-sores. Glycerin, as 
well as boroglycerin (see p. 88), is used extensively in various 
local applications in the treatment of diseases of women, and 
in congested states of the genital organs it is of special service 
by causing, on account of its affinity with water, an abundant 
serous transudation. For the use of glycerin with kaolin see 
Kaolin (p. 437). 



472 PHARMACOLOGY AND THERAPEUTICS. 

Internal. — On account of its sweetness glycerin is employed 
to a considerable extent as a flavoring agent. Large doses of 
glycerin sometimes cause purgation, but it is not a reliable 
remedy for this purpose, and alone is seldom given by the 
mouth as a laxative, except perhaps in the case of haemorrhoids, 
upon which it is asserted to have a peculiarly soothing effect. 
To produce efficient cathartic action it is advised that it should 
be combined with magnesium sulphate or carbonate, rhubarb, 
and tincture of belladonna. As a laxative, however, it is much 
more frequently administered by the rectum, where 4 to 8 c.c. 
(1 to 2 fl. dr.) produces a prompt evacuation, without pain 
or other disturbance; and the most convenient way to use it 
is in the form of the glycerin suppository. The glycerin is 
said to pass upwards as far as the sigmoid flexure, and even be- 
yond. While, from its contact with the epithelial walls, it may 
thus perhaps increase the peristalsis of the greater part of the 
large intestine, the local irritation of the lower portion of the 
rectum is itself no doubt sufficient to set up reflex movement 
of the bowel. Enemata of glycerin diluted with water, or, 
better, of glycerin combined with flaxseed tea, in the proportion 
of one to four, are of considerable service in dysentery; reliev- 
ing the tenesmus. Glycerin has been advised by some as a food 
in conditions of malnutrition, but, although it forms part of 
the composition of ordinary fats, it proves, as a rule, a very 
inferior substitute for codliver oil and other fatty substances. 
In the form of glyconin (Glyceritum Vitelli), however, it con- 
stitutes an admirable vehicle for the administration of cod- 
liver oil, and, given in this way, it is thought to increase the 
efficiency of the latter. On theoretical grounds it has been 
employed in the treatment of diabetes, but it appears to have 
little or no practical value in that disease. It was formerly 
used to a considerable extent by diabetics as a substitute for 
sugar, but its sweetness is of a kind rather disagreeable to many, 
and its place has now largely been taken by saccharin and 
levulose. Glycerin, it has been found, is capable of destroying 
trichinae in the intestinal tract, and it is therefore a remedy of 



ICELAND MOSS. 473 

distinct value in cases of trichiniasis. Among other conditions 
in which it has been used internally may be mentioned acne, 
vomiting of pregnancy, gallstone disease, and nephrolithiasis. 

ICELAND MOSS. 

Unofficial Preparations. 
Cetraria (U. S. P., 1890). — Cetraria. (Iceland Moss.) 
Decoctum Cetrarise. — Decoction of Cetraria. Dose, 0.30 to 

1.20 c.c; 1 to 4 fl. oz. 
Acidum Cetraricum. — Cetraric Acid. Dose, 0.03 to 0.12 

gm.; V2 to 2 gr. 

Action of Iceland Moss. 

Iceland moss is demulcent, nutritive and mildly tonic. It 
is also stated to have antihaemorrhagic properties. The cetraric 
acid gives its decoction a bitter taste, but this and the other 
acids which the moss contains can be removed, if desired, by 
soaking for some time in dilute alkaline solutions. It has been 
asserted that cetraric acid augments the number of the red and 
to a still greater degree, of the white blood-corpuscles, that it 
increases intestinal paralysis, and that it is a mild stimulant 
to the central nervous system. Intravenously injected, it is said 
to cause an increased secretion of saliva, bile and pancreatic 
juice. 

Therapeutics of Iceland Moss. 

The decoction is demulcent, and may be given in sore throat. 
Cetraria, as well as Irish moss, was formerly supposed to pos- 
sess some peculiar virtue in pulmonary affections, but this 
opinion is no longer held, and it is now almost entirely employed 
as an article of diet for the sick. As a food it is not of very 
high nutritive value, but it may at times serve a useful purpose. 
The jelly formed by boiling may be taken by diabetics and other 
invalids. It should be suitably flavored. The decoction, with 
its acids allowed to remain, may be used as a stomachic tonic 
in cases where the more active agents of this class are not well 
borne. Cetraria has been recommended in haemoptysis, in 



474 PHARMACOLOGY AND THERAPEUTICS. 

which condition it had long been employed by Danish physi- 
cians before it became generally known, and the powder, blown 
into the nostrils, has been found to arrest epistaxis. A tinc- 
ture of cetraria, locally applied, is of service in spongy gums. 
In Iceland the moss is regarded as prophylactic against a form 
of elephantiasis which prevails there. 

Cetraric Acid, given in accordance with the indications de- 
rived from the experiments on animals showing that it augments 
the digestive secretions, is said to have proved beneficial in 
dyspepsia. The acid has also been suggested as a remedy in 
anaemia and chlorosis, especially when associated with consti- 
pation, but no clinical evidence has as yet been educed of its 
utility in such conditions. 

IRISH MOSS. 

CHONDRUS.— Chondrus. (Irish Moss. Carragheen.) Dose, 15 
gm.; 4 dr. (in decoction). 

Action of Irish Moss. 

Irish moss is demulcent and somewhat nutrient, though the 
gum which enters largely into its composition does not digest 
very readily. 

Therapeutics of Irish Moss. 

The decoction (made by boiling 750 c.c. (1^2 pints) of water 
with 15 gm. (y 2 oz.) of the moss down to 500 c.c. (1 pint)) 
was formerly much more generally used than at present, in 
bronchial affections, diarrhoea, dysentery and irritation or in- 
flammation of the genito-urinary tract. Whatever beneficial 
effect it may have had was probably due to its protective quali- 
ties, and also possibly to some extent to the influence on nutri- 
tion of the minute quantity of iodine in it. When made into 
a jelly it is a pleasant article of diet. At one time this was 
supposed to constitute an important food in illness, but it is 
really of little practical value, as only -^ to -^ of the jelly is 
solid matter; the rest being water. Irish moss is also used as 
a vehicle in preparations of bone marrow. 



GELATIN. 475 

MARSHMALLOW. 
ALTERA. — Althaea. (Marshmallow.) 

Unofficial Preparations. 
Syrupus Althaeas (U. S. P., 1890). — Syrup of Althaea. Dose, 
freely. 

Asparaginum. — Asparagin. Dose, 0.06 to 0.12 gin.; 1 to 2 
gr. 

Action of Mash mallow. 
Marshmallow is demulcent, emollient and slightly nutritious. 

Therapeutics of Marshmallow. 
It is a useful demulcent for irritation and inflammation of 
mucous membranes. It is held in popular esteem, especially as 
a remedy for sore throat, and the confections of it are service- 
able in scarlet fever and diphtheria, as well as in ordinary 
pharyngitis. The decoction is sometimes given for gastric irri- 
tation and used locally in irritations of the vagina and of the 
rectum. An excellent emollient poultice is made from the 
powdered root, and, combined with benzoinated lard, marsh- 
mallow is employed as a bland dressing in cutaneous affections. 
It is a constituent in blue mass and in phosphorus pills, to which 
it serves to give the proper consistence, and the syrup is an 
agreeable vehicle. It is thought to be slightly diuretic on ac- 
count of the asparagin contained in it, and in the form of a 
fresh infusion it has been given to children, especially in 
Bright's disease. Asparagin itself has been recommended as a 
diuretic, though its value has not as yet been established. 

GELATIN. 

GELATINUM.— Gelatin. 

Preparation. 
Gelatinum Glycerinatum. — Glycerinated Gelatin. 

Action of Gelatin. 
Gelatin is a demulcent and styptic, and is also believed to be 
to some extent nutrient, as it increases vital action in the same 
direction, though not in the same degree, as albumin. 



476 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Gelatin. 
It is used as a basis for capsules, lozenges, bougies, supposi- 
tories and pessaries, as a coating for pills, and as a protective 
covering in certain diseases of the skin. An admirable basis 
for throat pastilles is the following, known as glycogelatin : 
gelatin, 2; glycerin, 5; orange flower water, 5; colored with 
carmine. Each should weigh 2 gm. (30 gr.), and any desired 
medicinal agent may be incorporated in such pastilles. As a 
covering for the skin Unna's zinc-gelatins, which are dis- 
pensed in small cubes, are extremely serviceable. After being 
melted they are painted over the affected surface, and the part 
is then covered with a layer of cotton wool. Perhaps those in 
most frequent use are zinc gelatin with ichthyol, 1 to 5 per 
cent., with phenol, 1 to 3 per cent, with sulphur, 5 per cent., 
and with resorcinol, 2 per cent. As an antidote, gelatin is of 
especial value against iodine, bromine and the alums, but re- 
quires too much time for its preparation, as for this purpose it 
should be broken up and reduced to the consistency of honey by 
being soaked for half an hour in water. Sterilized gelatin in 
solution has been administered subcutaneously to increase the 
coagulability of the blood in aneurism. 

STARCH. 

AMYLUM.— Starch, Corn Starch. 

Preparation. 
Glyceritum Amyli. — Glycerite of Starch. 

Action of Starch. 
Starch is demulcent and nutritive. It and its derivative, 
grape-sugar, are the chief members of the non-nitrogenous 
group of alimentary principles known as carbohydrates. In 
the animal economy starch undergoes digestion by ptyalin, pan- 
creatin and the secretion of the intestinal glands, which convert 
it first into soluble dextrin and then into grape-sugar, in which 
form it passes into the blood. The non-nitrogenous principles 



SUGAR OF MILK. 477 

(starches, sugars and fats) are mainly concerned in heat-pro- 
duction. The excessive consumption of starchy food delays 
tissue-metamorphosis, causes a redundancy of fat, and often 
gives rise to acidity and flatulence. Undigested starch passes 
into the faeces, and the urine may become saccharine. 

Therapeutics of Starch. 
Medicinally starch is inert, and it is used principally on ac- 
count of its mechanical properties, which make it a good basis 
for dusting powders and insufflations. The mucilage (i to 40), 
which is made by gradually adding the starch and then boiling 
and stirring for a few minutes, is a convenient basis for 
enemata. It may also be used as a basis for ointments and to 
suspend insoluble powders or oils, though it is open to the 
objection that it keeps badly. The glycerite is a very soothing 
local emollient, and is also employed as a basis for suppositories. 
A starch poultice (made by enclosing clear starch, prepared as 
in the laundry, between folds of soft muslin) is also a very 
soothing application in inflammatory conditions of the eye or 
lids. Mixed with glue, starch makes an excellent stiff bandage 
for surgical purposes. Starch is employed as an antidote in 
poisoning by iodine or bromine. 

SUGAR OF MILK. 

SACCHARUM LACTIS.— Sugar of Milk. (Lactose.) 

Action of Sugar of Milk. 

Sugar of milk is a non-nitrogenous, bland article of diet, 

which is less apt to ferment in the gastro-intestinal tract than 

cane- or grape-sugar. It is stated by some authorities to be 

a very active diuretic, especially when cardiac dropsy is present. 

Therapeutics of Sugar of Milk. 
Being very hard, and also but slightly deliquescent, it is a 
valuable excipient for powders requiring the minute subdivis- 
ion of their medicinal constituent and as a diluent to bring 



478 PHARMACOLOGY AND THERAPEUTICS. 

extracts to the required strength. It has been used as a carbo- 
hydrate food in consumption and other wasting diseases, and, 
on account of its smaller liability to ferment, is preferred to 
cane-sugar for the sweetening of infant's food. It is also a 
serviceable food in acute febrile diseases, and, being tasteless 
and easily soluble in most fluids, it may often be taken with 
advantage to the extent of 30 to 60 gm. (1 or 2 oz.) a day. 
According to the observers mentioned above, it is a diuretic 
which may be employed with good results in cardiac dropsy. 
By them it is claimed that it causes a greater excretion of 
urine than any other drug, acting even more powerfully than 
caffeine, and without any of the disadvantages of the latter. 
It is said, however, that its diuretic action is but very slight in 
cases where extensive renal disease exists. 

MUSTARD. 

1. SINAPIS ALBA. — White Mustard. Dose (emetic), 8 gm.; 
120 gr. 

2. SINAPIS NIGRA.— Black Mustard. Dose (emetic), 8 gm.; 
120 gr. 

Preparation. 
Charta Sinapis. — Mustard Paper. 

3. OLEUM SINAPIS VOLATILE.— Volatile Oil of Mustard. 
Dose, 0.008 c.c; y 8 rty. 

Unofficial Preparation. 
Linamentum Sinapis Compositum (U. S. P., 1890). — Com- 
pound Liniment of Mustard. 

Action of Mustard. 
External. — Oil of mustard differs from the other volatile oils 
in that it produces a markedly greater irritation. Being ex- 
tremely diffusible, it has a very deep action, without producing 
very profound destruction of the surface. Locally applied, mus- 
tard is a rubefacient, counter-irritant, and nervous stimulant, 
causing heat, redness, and severe burning pain. These effects 



MUSTARD. 479 

are produced by its action in dilating the blood-vessels and 
irritating the sensory nerves. The stimulation of the latter is 
followed by their paralysis, in consequence of which there re- 
sults a local loss of sensibility. If the application is sufficiently 
prolonged, it induces vesication, the irritation of the vessels 
leading to the transudation of plasma, which raises the epider- 
mis and thus forms vesicles or blisters. The blistering caused 
by it is more painful and heals less rapidly than that of can- 
tharides, which is no doubt due to the fact that the oil of mus- 
tard penetrates more deeply into the tissues and thus sets up 
more extensive inflammation. When the crude drug, mois- 
tened, is applied to the skin, the oil is found to form only 
slowly, so that the action of the irritant becomes continuously 
more intense. The excitation of the sensory nerves caused by 
the external application of mustard is sufficiently powerful to 
induce more or less reflex stimulation of the heart and respira- 
tion, and sometimes to restore consciousness to those suffering 
from syncope. 

Internal. G astro -intestinal Tract. — Mustard is also a power- 
ful irritant to the alimentary canal. In small amounts it is 
taken as a condiment and stimulates the appetite. It has gen- 
erally been supposed to increase the secretion of gastric juice, 
but this is said not to be the case. Large doses irritate the 
stomach and produce prompt vomiting, which, in consequence 
of the reflex stimulation of the heart and respiration caused by 
the drug, is not attended with the depression usually resulting 
from emetics. The emetic effect is increased by giving the 
mustard in a considerable quantity of lukewarm water. The 
oil of mustard is an energetic irritant, a single drop upon the 
tongue producing an intense burning pain in the nose, throat 
and stomach. Mustard seeds, swallowed whole, have a laxative 
effect upon the bowels, and as they are discharged in the faeces 
without perceptible change, would appear to act merely by 
mechanically stimulating the intestine. 

General Action. — Upon the organs and tissues mustard, in 
ordinary doses, has very little appreciable effect, but very large 



48O PHARMACOLOGY AND THERAPEUTICS. 

doses of the oil prove fatal to rabbits. The action of the 
heart is at first increased and then diminished, the respiration 
becomes impeded, insensibility follows, and a fall of surface 
temperature precedes death. Post mortem there is found red- 
ness, but only slight inflammation, of the gastro-intestinal tract, 
with destruction of the epithelium. The kidneys are also hyper- 
semic, and the blood is said to smell of mustard. 

Therapeutics of Mustard. 
External. — A mustard plaster or sinapism is a very useful 
means of relieving pain in gastralgia, colic, neuralgia, chest 
affections, lumbago, and a great variety of other conditions. 
While the application itself may be temporarily painful, the 
secondary effect, both as to the pain due to the mustard and 
that from the condition present, is soothing, in consequence of 
the loss of sensibility resulting from the paralysis of the sensory 
nerves produced by the drug. Sinapisms are prepared by mix- 
ing mustard (to which an equal quantity of flour is usually 
added to render the effect less severe), with warm water to a 
smooth paste, which is spread upon linen. A layer of muslin 
or thin unglazed paper is usually placed between the mustard 
and the skin. As a rule, they are best applied a little distance 
from the seat of pain. Thus, to relieve headache they are most 
serviceable when placed at the nape of the neck. Sinapisms are 
also applied to the epigastrium in persistent vomiting, to the 
loins in suppression of urine, to the precordial region in 
threatened syncope, and to the calves of the legs and other 
parts of the body in narcotic poisoning, asphyxia or syncope. 
In the latter conditions the object is, of course, to arouse the 
nervous system, but in all cases of insensibility care should 
be taken that the application is not continued too long, on ac- 
count of the danger of causing vesication or even more serious 
local trouble. In the case of children the proportion of mus- 
tard employed should not exceed one-fourth. The mustard 
leaves and papers sold in the shops are very convenient for 
ready use. They are generally very strong, however, and one 



MUSTARD. 48I 

or two layers of moistened linen should be placed between the 
sinapism and the skin to prevent too great an action. In the 
official Charta Sinapis a surface of 60 square c.c. contains 
about 4 gm. of black mustard deprived of oil. One advan- 
tage which mustard possesses for the purpose of revulsion is 
the readiness with which its action may be controlled by the 
regulation of the strength of the application and the time which 
it is allowed to remain. In many cases it is desirable to main- 
tain for hours a mild, equable, counter-irritant impression, and 
this may be done by adding about one-sixteenth part of mus- 
tard to a flaxseed poultice. In bronchitis, pleurisy or pneu- 
monia a "jacket poultice" is often applied to the chest, and 
the larger the poultice the more pronounced is the effect upon 
the internal organs. Large mustard poultices are also used with 
advantage in acute inflammations of the abdominal viscera. 
When it is desired to dilate the peripheral vessels over a large 
area, in order to withdraw blood from internal parts and thus 
produce a " derivative effect," a hot bath to which mustard is 
added (1 to 128) is often serviceable. A general mustard bath 
is chiefly employed for children in the early stages of febrile 
diseases or bronchitis. In older persons a hot mustard foot- 
bath (which ought to reach nearly to the knees) is useful for 
the relief of incipient common colds and various febrile con- 
ditions. A hot mustard sitz-bath is commonly employed, just 
before the expected period, to induce menstruation. In place 
of the sitz-bath the foot-bath is sometimes used for this pur- 
pose, as well as to relieve the congestive headaches, hot flush- 
ings, and nervous symptoms often met with at the time of the 
menopause. 

Internal. — A tumblerful of lukewarm water, with the addi- 
tion of 4 to 15 gm. (1 to 4 teaspoonfuls) of mustard is in 
general use as an emetic, and is especially advantageous in 
cases of narcotic poisoning by reason of the reflex stimulation 
caused by the mustard. Otherwise the drug is not very often 
employed internally, except as a condiment, though it may 
occasionally prove of service. White mustard seeds have some 
32 






482 PHARMACOLOGY AND THERAPEUTICS. 

reputation as an emmenagogue, and obstinate hiccough is said 
to have been relieved by an infusion of mustard, 4 gm. (1 tea- 
spoonful) to 120 c.c. (4 fl. oz.) of water. In the treatment of 
dropsy a mustard- whey, made by boiling 15 gm. (y 2 oz.) of 
mustard-flour in 500 c.c. (1 pint) of milk, and an alcoholic solu- 
tion of the oil of mustard have both been sometimes used with 
good effect, and the latter preparation has been found of more 
or less service in chronic bronchial and gastric catarrh. 

OIL OF CAJTTPUT. 
OLEUM CAJUPUTL— Oil of Cajuput. Dose, 0.5 c.c; 8 TTl . 

Unofficial Preparation. 
Oleum Miaouli. — Oil of Miaouli. Dose, .12 to .60 gm.; 2 to 
10 grs. daily. 

Action of Oil of Cajuput. 
The action of oil of cajuput, externally and internally, is 
identical with that of the oil of cloves. 

Therapeutics of Oil of Cajuput. 

External. — Being a strong, stimulating rubefacient and irri- 
tant, it is rubbed into the skin — usually diluted with olive oil — 
in a variety of conditions such as muscular rheumatism, chil- 
blains, nervous headaches, and chronic inflammatory affections 
of the joints and periosteum, as well as in such cutaneous 
diseases as chronic eczema, psoriasis and rosacea. In alopecia 
it is used as an ingredient of various stimulating ointments. 
On account of its parasiticidal properties it is also of service 
in the treatment of tinea, scabies, etc. Like many other oils 
of its class, it will relieve toothache if introduced into the 
hollow of the carious tooth. To some individuals its strong 
odor makes it rather objectionable as an application. 

Internal. — Being a stimulant carminative, it is useful in flatu- 
lent colic and other varieties of dyspepsia, and it is also of ser- 
vice in spasmodic affections of the stomach and bowels. In 



EUCALYPTUS. 483 

these conditions it is usually associated with other remedies. 
It sometimes proves successful in relieving nervous dysphagia, 
vomiting, hiccough, dyspncea and dysmenorrhea. It has been 
given as a diffusible stimulant in typhoid and other low fevers, 
and in doses of 1 to 4 c.c. (15 to 60 ni) has even yielded good 
results in the collapse stage of cholera. It is furthermore said 
to have been used with benefit in chronic rheumatism, laryn- 
gitis, bronchitis and catarrh of the bladder, as well as in ele- 
phantiasis and certain other skin diseases. It has also been ad- 
ministered as a vermifuge, and prescribed, in the form of an 
emulsion, as an injection for thread-worms. As an internal 
remedy it may be taken on sugar or swallowed in capsules. 

Oil of Miaouli. — It seems probable that more or less of the 
cajuput oil of commerce is derived from two trees of New 
Caledonia, the Melaleuca flaviftora and the Melaleuca viridi- 
Uora. The oil of miaouli, or niaouli, which is distilled from 
their leaves, is described as of a pale-yellow color and anal- 
ogous in chemical composition to terpinol, and is said to pos- 
sess properties very similar to those of oil of cajuput. It is 
reported to have been used with benefit in bronchitis and to 
have a marked effect in diminishing the expectoration in pul- 
monary tuberculosis, and it has also been employed for the pur- 
poses for which oil of cajuput is usually given. It is best ad- 
ministered in capsules. 

EUCALYPTUS. 

1. EUCALYPTUS.— Eucalyptus. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Eucalypti. — Fluidextract of Eucalyptus. 
Dose, 2 c.c; 30 TTL- 

2. OLEUM EUCALYPTI.— Oil of Eucalyptus. Dose, 0.5 c.c; 

8 Tt\. > 

3. EUCALYPTOL.— Eucalyptol. Cineol. Dose, 0.3 c.c; 5 TT],. 



484 PHARMACOLOGY AND THERAPEUTICS. 

Action of Eucalyptus. 

External. — Oil of eucalyptus is a very active disinfectant. 
Old oil is said to have greater antiseptic power than new, and 
this is thought to be due to the larger amount of ozone which 
it contains. As regards the antiseptic properties of eucalyptus 
oil, ozone is regarded as its most valuable constituent, and next 
to this come the pinenes and other terpenes, which are not only 
antiseptic in themselves, but are the agents in the production 
of the ozone. Recent experiments indicate that eucalyptol is 
the weakest antiseptic of all, and that it is chiefly valuable as 
a carrier of ozone. Oil of eucalyptus is a rubefacient, but less 
irritant to the skin than oil of turpentine and some other volatile 
oils. If evaporation is prevented, however, it will produce vesi- 
cation, and even pustulation. 

Internal. Gastro-intcstinal Tract. — Ordinarily it produces 
very much the same effects as oil of turpentine in small doses, 
but large amounts of it are capable of exciting indigestion with 
eructations, and nausea, vomiting and diarrhoea, with severe 
abdominal pain. 

Circulation. — In doses such as promote appetite and diges- 
tion it increases the heart's action and causes a rise of blood- 
pressure ; effects which are no doubt due to the reflex stimula- 
tion from the stomach. Large doses depress the heart and 
cause a fall of blood-pressure, at the same time producing great 
muscular weakness and lowered temperature. As the arterial 
pressure falls in animals after section of the spinal cord or of 
the vagi, as well as after atropine, eucalyptus has been thought 
to act directly upon the heart. The leucocytes of the blood are 
restricted in their movements, diapedesis is prevented, and pus 
formation diminished. The surface of the red corpuscles has 
been observed to appear wrinkled, and the nucleus, when pres- 
ent, more distinct. 

Respiration. — While small doses slightly accelerate the re- 
spiration, large doses depress it, and in toxic amount it causes 
paralysis of this function by direct action on the respiratory 
centre in the medulla. 



EUCALYPTUS. 485 

Nervous System. — As in the case of turpentine, the stimula- 
tion of the central nervous system is only very transient, and 
is followed by marked depression. It is stated to be even a 
more pronounced depressant than turpentine, though conscious- 
ness is retained for a longer time. Under large or toxic doses 
the brain, medulla, and spinal cord are all affected, the reflexes 
are abolished, and loss of sensation in the lower limbs may 
occur. Small doses have the effect of stimulating mental 
activity. 

Spleen. — Like quinine, eucalyptus, it is believed by some, 
has the power of causing contraction of the spleen, though 
to a much smaller degree. It has also been thought to be more 
or less antiperiodic, but that it has any specific action of this 
kind is denied by competent authorities, on the ground that it 
has the same constituents as several other oils, and seems to 
have no peculiar qualities. 

Absorption and Excretion. — It is absorbed from the skin, 
respiratory mucous membrane, and alimentary canal, and is' 
excreted by the skin, the respiratory and other mucous mem- 
branes, and the kidneys. It imparts its odor to the breath 
and the urine, and is somewhat irritant at the points of elimi- 
nation. It therefore has more or less action as a diaphoretic, 
expectorant, diuretic, and stimulant to the genito-urinary tract. 

In a case of fatal poisoning by oil of eucalyptus death was 
preceded by great embarrassment of respiration. Post mortem 
there was found a large quantity of blood in the pleural cavi- 
ties, the lungs were collapsed and bloodless, and the right heart 
contained frothy blood. 

Therapeutics of Eucalyptus. 
External. — It is used as an antiseptic in surgery, and is pre- 
ferred by some to phenol, as it is said to be three times as 
energetic as the latter. As a wash or dressing for wounds, 
sores, etc., and especially for chronic, indolent, or unhealthy 
ulcers, the tincture or the water of eucalyptus (neither official), 
or a weak solution of the oil in alcohol, may be employed. An 



486 PHARMACOLOGY AND THERAPEUTICS. 

ointment of eucalyptus, containing 10 per cent, of the oil, is 
official in the British Pharmacopoeia, and a eucalyptus gauze is 
also available. A soap (sapo eucalyptoli), containing 5 per 
cent, of the oil, is of service in the treatment of foul wounds 
or ulcers and of bromidrosis. An ointment composed of 
eucalyptus, 8 ; iodoform, 1 ; hard paraffin, 40 ; vaseline, 40, is 
a good application for chancres and chancroids, and the oil 
in the form of an emulsion (1 to 50), may be advantageously 
used as an injection in gonorrhoea. The oil has been employed 
as a mild counter-irritant in affections of the chest and of the 
joints, and its local stimulant effects sometimes prove valuable 
in the treatment of anidrosis and of alopecia when a thickened 
and vitiated sebum occludes the glands and covers the scalp. 
It is a serviceable addition to other medicaments in ointments 
for chronic eczema and other cutaneous affections. A 10 per 
cent, solution of eucalyptol in pure alcohol has been used as a 
local antiseptic application in diphtheria, and the oil in a 
vaporized state has been employed for inhalations in this dis- 
ease. Similar inhalations may likewise be given in pulmonary 
tuberculosis, dilated bronchi, bronchitis with fetid expectora- 
tion, gangrene of the lungs, ozsena, etc. In phthisis not much 
is to be hoped for in the way of permanent benefit, as the tuber- 
cle bacillus has been found to be peculiarly resistant to the 
action of the volatile oils. In asthma, eucalyptus-leaves are 
sometimes smoked in cigarettes made with stramonium-leaves 
and belladonna or cocoa, but how much of the benefit derived 
from their use is attributable to the eucalyptus seems rather 
uncertain. A decoction of the leaves is an efficient local appli- 
cation in stomatitis, pharyngitis, tonsillitis, etc., after the sub- 
sidence of the acute stage. It may also be used as an injec- 
tion for thread-worms. In cancer of the rectum or uterus the 
topical application of eucalyptus frequently diminishes the 
amount and fetor of the discharges. 

It is worth noting that eucalyptus is of service in preserving 
solutions of alkaloids designed for hypodermatic use. An 
aqueous preparation will prevent the development of the peni- 



EUCALYPTUS. 487 

cillium which rapidly destroys the alkaloid when the solution 
is made with simple distilled water. 

Internal. — Eucalyptus is useful as a stomachic and carmina- 
tive, provided no inflammatory action is present, in atonic dys- 
pepsia, and in chronic gastric and intestinal catarrh. In con- 
sequence of its action the alimentary tract becomes more 
healthy, and no longer affords a place of development for para- 
sites, and it is especially efficient in the form of vomiting and 
indigestion caused by sarcinse. In convalescence from acute 
disease, in debility arising from defective assimilation, and in 
cachectic conditions generally, it strengthens the action of the 
heart and often constitutes a satisfactory tonic and stimulant. 
Hysteria, neurasthenia, chorea, and similar conditions, as well 
as cerebral anaemia, may be benefited by eucalyptus, and, like 
oil of cajuput, it is likely to be of service in the nervous phe- 
nomena which characterize the climacteric period. It has been 
known to afford decided relief in the headache which accom- 
panies epidemic influenza, and may sometimes likewise prove 
efficacious in migraine and other forms of headache. The 
remedy is especially valuable in subacute and chronic catarrhal 
affections of the bronchial mucous membrane and that of the 
genito-urinary organs, by both of which it is excreted. There 
seems to be no question of its value in the declining stage of 
pneumonia, in pulmonary gangrene, in chronic bronchitis, and 
particularly in bronchorrhcea and fetid bronchitis. It has been 
given in tuberculosis, in the hope that in its excretion through 
the lungs it would exercise an antiseptic action. The objection 
has been raised, however, that the traces excreted in this way 
are quite incapable of any noticeable effect on microbial growth, 
while, as has been mentioned, the tubercle bacillus appears to 
be peculiarly resistant to this class of remedies. Among the 
genito-urinary affections in which it has been found of ser- 
vice may be mentioned chronic desquamative nephritis, granular 
degeneration of the kidneys, pyelonephritis, hydronephrosis, 
gleet, vaginitis, and particularly chronic catarrh of the bladder. 
In these conditions it is necessary, however, to administer it 



488 PHARMACOLOGY AND THERAPEUTICS. 

with caution and not to use it too long continuously, on account 
of the danger of exciting renal congestion and irritation. In 
the hope that it might prove beneficial as an antipyretic and in- 
ternal antiseptic, oil of eucalyptus has been given both by the 
mouth and by hypodermatic injection in pyaemia, septicaemia 
and puerperal fever, as well as in typhoid and scarlet fevers. 
While the results from its use have sometimes appeared to be 
favorable, the remedy would seem to possess no special advan- 
tages over the other volatile oils. For subcutaneous use it is 
diluted with olive oil (i to 4). 

There is considerable difference of opinion as to the value 
of eucalyptus in malarial fever. By some it was at one time 
thought, like quinine, to have a specific action in this disease, 
but this opinion has now been abandoned by most observers. 
If it has any such effect at all, it is positive that it is vastly 
inferior to that of the cinchona preparations. At the same 
time, it appears to have a certain amount of usefulness as a 
remedy for malarial conditions, and some of the most experi- 
enced clinicians have found it very serviceable in the con- 
valescence from intermittent and remittent fevers and in chronic 
malarial poisoning. While it cannot by any means take the 
place of quinine in arresting the paroxysms or preventing re- 
lapses at the septenary periods, it is asserted that it is even 
more useful than that remedy for reconstructing the damages 
in the organs of assimilation occasioned by the malarial in- 
fection. It has sometimes proved curative in cases where 
quinine had failed. Eucalyptus trees have been largely culti- 
vated in malarial regions, with the effect of often improving 
markedly the healthfulness of such districts. This result has 
been attributed in part to the action of the eucalyptus in puri- 
fying the atmosphere in its vicinity by its aseptic emanations, 
but it would seem to be due rather to the drying of the soil, 
in consequence of the large amount of water withdrawn from 
it by the rapidly growing tree. 

In most instances eucalyptol can be substituted for the oil 
with advantage. 



ARNICA. 489 

OIL OF ROSEMARY. 
OLEUM ROSMARINI.— Oil of Rosemary. Dose, 0.2 C.C.; 3 TF\. 

Action of Oil of Rosemary. 
The action of oil of rosemary is like that of other similar 
volatile oils. It is said, especially when inhaled, to reduce the 
body-heat and impart to the urine a violaceous odor. 

Therapeutics of Oil of Rosemary. 

Rosemary was formerly employed to some extent as an era- 
menagogue, galactagogue and diuretic., but is not now used with 
these actions in view. The chief use of the oil is as an external 
stimulant in lotions, liniments and ointments. In facial acne 
it is thought to have a special beneficial action. It is frequently 
prescribed with tincture of cantharides and Cologne water in 
alopecia resulting from defective nutrition of the hair-bulbs, 
and, on account of its parasiticidal property, it is efficacious in 
applications for scabies and the different varieties of pediculosis. 
As an ingredient of rubefacient liniments it is serviceable for 
sprains and painful joints, and the compound rosemary oint- 
ment of the German Pharmacopoeia (consisting of one part 
each of the oils of rosemary and juniper-berries in thirty parts 
of ointment), may be employed in neuralgia, lumbago, chronic 
rheumatism, etc. Oil of rosemary is also largely used simply 
to give a pleasant scent to lotions and other preparations for 
external use. 

Internally, it is occasionally given as a carminative in flat- 
ulence and colic and as a stimulant in hysteria accompanied 
by depressed spirits. 

It enters into the composition of soap liniment and the com- 
pound tincture of lavender. 

ARNICA. 

ARNICA. — Arnica (Arnicae Flores, U. S. P., 1890). Dose, 1 gm.J 
15 gr. 

Preparation. 
Tinctura Arnicae. — Tincture of Arnica. Dose, 1 c.c; 15 n\. 



490 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Trimethylamini Hydrochloras. — Trimethylamine Hydrochlo- 
rate. Dose, 0.12 to 0.30 gm.; 2 to 5 gr. 

ARNICA RADIX (U. S. P., 1890; no longer official).— Arnica 
Root. Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

Unofficial Preparations. 

1. Extractum Arnicae Radicis (U. S. P., 1890). — Extract of 
Arnica Root. Dose, .30 to 1.20 gm.; 5 to 20 gr. 

2. Extractum Arnicae Fluidum (U. S. P., 1890). — Fluidextract 
of Arnica Root. Dose, .30 to 1.20 C.C.; 5 to 20 nT.. 

3. Tinctura Arnicae Radicis (U. S. P., 1890). — Tincture of 
Arnica Root. Dose, .30 to .60 c.c; 5 to 10 n\. 

4. Emplastrum Arnicae (U. S. P., 1890). — Arnica Plaster. 

Action of Arnica. 
On account of its volatile oil, arnica has the same action as 
the volatile oils in general. In large doses it is a gastroin- 
testinal irritant, causing vomiting and purging, and also pro- 
duces headache, unconsciousness, fall of temperature, paralysis 
of the nervous system (motor and sensory), and sometimes 
collapse and death. In some cases convulsions occur. In 
moderate doses it slows the pulse, raises the blood-pressure 
slightly, and stimulates the vagus nerves, while toxic amounts 
produce a rapid pulse from paralysis of these nerves. Arnica 
is excreted mainly by the kidneys and mucous membranes. 

Therapeutics of Arnica. 
External. — The diluted tincture is used for myalgia, sprains, 
bruises and external inflammations generally, and is a very 
popular domestic remedy for such affections. It should not 
be applied if the skin is broken, and should always be used 
with caution if the integument is sensitive. Some individuals 
appear to have a special indiosyncrasy in respect to arnica, and 
in such there may be caused by it violent cutaneous inflamma- 
tion, with the production of pustules, or even distinct bullae, 



ARNICA. 491 

attended with severe constitutional symptoms. The idiosyn- 
crasy is found to be often marked in the gouty. It is said, 
however, that this untoward action has not been observed from 
preparations made from the root. Some authorities assert that 
any good effects which tincture of arnica may have, such as 
causing absorption of ecchymoses, are in reality due to the 
alcohol; on the other hand, it is claimed that the infusion (not 
official), which is made with water only, is even more efficacious 
as a local application than the tincture. The aqueous prepara- 
tion, it is also said, promotes the rapid union of cut surfaces. 
Clinical experience shows that arnica often has a very effec- 
tive local action, particularly in rheumatism, boils, abscesses, 
and in all thickened conditions of the integument, and that it 
also has some influence over haemorrhages. For boils, ab- 
scesses and thickening of the skin an application consisting 
of equal parts of fluidextract of arnica root (not official), 
soap liniment, and tincture of opium is recommended, and for 
haemorrhages, one of equal parts of fluidextract of arnica root 
and distilled witchhazel water, to be used on lint or muslin. 
A rheumatic joint may be covered with cloths saturated with 
the latter combination, which is often more efficient when ap- 
plied hot. Arnica plaster sometimes affords a very useful 
means of employing the drug locally. 

Internal. — Except as a stomachic, carminative and reflex 
stimulant, when given in small doses, many writers consider 
arnica, internally, as too unreliable in its effects to be of much 
therapeutic value. Others, however, confidently assert that it 
is a remedy of distinct usefulness in a very considerable variety 
of conditions. Thus, it is claimed that ecchymoses are rapidly 
dispersed by its internal, as well as its external administration, 
and that for internal contusions from shock or concussion its 
use by the mouth has proved very efficacious. Furthermore, 
that it has rendered good service in typhus and typhoid fevers 
(as a stimulant and antipyretic), delirium tremens, rheumatism 
and rheumatic gout, epistaxis, haemoptysis and other haemor- 
rhages, amaurosis, concussion of the brain, paralysis of the 



492 PHARMACOLOGY AND THERAPEUTICS. 

bladder, and chronic dysentery. The assertion is made that it 
has often checked an exhausting diarrhoea after many other 
remedies have failed, and that in aqueous preparation it has 
given great satisfaction in idiopathic mania, after the first ex- 
citement has diminished. It has also been found beneficial in 
acute eczema, in erysipelas, and in other cutaneous affections 
of gouty or rheumatic origin. Many of these claims would 
seem to be exaggerated. 

Trimethylamine (C 3 H N), a compound which is frequently 
incorrectly called propylamine, with which it is isomeric, has 
been obtained from arnica flowers and those of several other 
plants, as well as from decomposing albuminous substances, 
such as herring-pickle and human urine. In its pure state it 
is a colorless, thin, and strongly alkaline liquid, having a marked 
ammoniacal odor modified by the peculiar odor of herring- 
pickle, and boiling at 9.8 C. (49. 6° F.), while at ordinary 
temperatures it is a colorless inflammable gas. It is readily 
soluble in water and alcohol. The hydrochlorate, its most stable 
salt, which crystallizes in white or colorless prisms and is very 
deliquescent, is also freely soluble in water and alcohol. In 
doses of .12 gm. (2 gr.) every three hours it is said to be a 
powerful antipyretic, and it has been used with considerable suc- 
cess in acute rheumatism and gout. In chronic rheumatism a 
liniment (1 to 3 of glycerin) has also afforded great relief; and 
it has been suggested that the fact that arnica contains tri- 
methylamine is probably the true explanation of the utility of 
that drug in rheumatic and gouty affections. Trimethylamine, 
when given to the extent of 1 to 1.30 gm. (15 to 20 gr.) a day, 
has been reported as efficient in the treatment of chorea, greatly 
moderating the spasmodic movements when not altogether pre- 
venting them. 

MEZEREUM. 

MEZEREUM.— Mezereum. (Mezereon.) Dose, 0.500 gm. (500 
milligm.); 7V 2 gr. 

Preparation. 
Fluidextractum Mezerei. — Fluidextract of Mezereum. 



ELEMI. 493 

Action of Mezereum. 

External. — Mezereum has the same action as volatile oils 
generally. It is a powerful rubefacient and vesicant externally. 

Internal. — It is a gastric stimulant, producing in large doses, 
vomiting and diarrhoea. 

Therapeutics of Mezereum. 

External. — It has been used chiefly in the compound mustard 
liniment (no longer official), where it excites the same effects 
and is employed for the same purposes as the oil of mustard. 
Almost its only other external use at present is to keep open 
an issue, a procedure which is now very rarely employed. Un- 
guentum Mezerei was official in U. S. P., 1880. In the mouth, 
however, mezereum-bark has been successfully employed to 
relieve toothache, and also as a sialogogue. 

Internal.— Internally its use is now practically restricted to 
its administration, in combination with sarsaparilla, as an alter- 
ative in syphilis, chronic rheumatism, and chronic skin diseases, 
in all of which its value is very doubtful. It is an ingredient 
of both the compound decoction (no longer official) and the 
compound fluidextract of sarsaparilla. 

ELEMI. 

ELEMI.— Manila Elemi (not official). 

Action of Elemi. 
Elemi acts like volatile oils generally. 

Therapeutics of Elemi. 
It is only used as a stimulating disinfectant ointment which 
was formerly official in B. P. as elemi, 1 ; ointment, 4. In this 
country it is very rarely prescribed. 

Division V. — Drugs Acting on the Skin. 
While the drugs described in Division IV act on the cutaneous 
vessels, in addition we have — 



494 PHARMACOLOGY AND THERAPEUTICS. 

A. Diaphoretics, or drugs which increase the amount of per- 
spiration. These may do this: (i) By affecting the circula- 
tion in the skin. This may be locally (by local irritation) or 
systemically. In the latter case the action may be an indi- 
rect one, and due to a rise of general blood-pressure if the 
cutaneous vessels are not at the same time constricted; or a 
direct one, due either to stimulation, direct or reflex, of the 
central dilator mechanism of the cutaneous vessels, or to 
paralysis of the vaso-constrictor mechanism of these vessels. 
(2) By directly augmenting the secretory activity of the cells of 
the sweat glands, either through stimulation, direct or reflex, 
of the sweat centres in the spinal cord, or through peripheral 
stimulation of the terminations of the nerves in the glandular 
cells themselves. As it is difficult to decide whether drugs 
acting on the vessels do not affect the other parts of the 
mechanism, and also whether a drug acts on the gland-cells or 
on the nerve endings, diaphoretics will be considered under 
two headings only: (a) those acting peripherally, and (b) 
those acting centrally. These are differentiated by observing 
whether the drug acts on a part of the skin after- division of the 
nerves going to it or whether it acts after destruction of the 
spinal cord. 

(a) Diaphoretics acting peripherally : Pilocarpine greatly increases 
the amount of sweat, acting on the nerve terminations in the gland- 
cells, but not on the vessels. Nicotine also acts peripherally. Local 
applications of warmth, and Alcohol taken internally perhaps act in 
the same way in addition to their vascular action. 

(b) Diaphoretics acting centrally: 



(1) Antimony salts. 

(2) Ammonium acetate. 

(3) Ammonium citrate. 



(4) Ipecacuanha. 

(5) Opium. 

(6) Camphor. 



(c) Diaphoretics zvhose mode of action is doubtful: Potassium Ci- 
trate and acetate, senega, cubeb, colchicum, salicin, lobelia, arnica and 
aconite. All these, except the first two, are very feeble. 

When a diaphoretic acts very powerfully it is called a Sudorific, 



DRUGS ACTING ON THE SKIN. 495 

B. Anhidrotics, or Antihidrotics, drugs which diminish the 
amount of perspiration. The part on which these act is de- 
termined in the same way as in the case of diaphoretics. 

(a) Anhidrotics acting peripherally : Atropine is very powerful; it 
acts on the terminations of the nerves in the glands, and hyoscyamus 
and stramonium apparently act in the same way. The local applica- 
tion of cold has a similar action. 

(b) Anhidrotics the mode of action of which is doubtful: 



(1) Acids. 

(2) Nux vomica. 

(3) Quinine. 

(4) Picrotoxin. 



(5) Zinc salts. 

(6) Salicylic acid. 

(7) Camphoric acid. 



Therapeutics. — Diaphoretics are used for the following pur- 
poses: (1) To remove fluid from the body, as hy causing the 
absorption of exudates. (2) To relieve diseased and overtaxed 
kidneys; for this purpose pilocarpine is much used. (3) To 
remove poisons introduced from without. or formed in the body. 
Pilocarpine is also used to promote excretion by the sweat in 
uraemia and similar conditions. (4) To re-establish disturbed 
circulation in the skin, in order to relieve internal congestions, 
break up an incipient " cold," bring out the rash in exanthemata, 
promote defective nutrition of the skin in certain cutaneous 
diseases, etc. The increased vascularity of the skin is also made 
use of to facilitate the absorption of local medicaments, such 
as ointments. Diaphoretics act as mild antipyretics. (5) To 
increase the alkalinity of the tissues, as in gout, oxybutyric acid 
coma (diabetes), etc. For this purpose drugs which directly 
stimulate the glandular activity are required, as the sweat is 
acid only when produced in this manner. It has been shown 
that an injection of pilocarpine is so effective in removing acid 
that it will render the urine of a healthy person markedly alka- 
line. In general, the sweat which results from increased circu- 
lation contains less solid matters and is more alkaline, while 
that resulting from direct action on the glands is more con- 
centrated and less alkaline. This is the character of the cold 
sweat which carbon dioxide produces by stimulating the sweat 



496 



PHARMACOLOGY AND THERAPEUTICS. 



centres, and which is often of serious import in the course of 
a disease, as indicating asphyxia. Certain drugs when taken 
internally are excreted in the sweat. Among them may be men- 
tioned iodine, iodides, and tartaric, succinic and benzoic acid, 
the latter in the form of hippuric acid. 

Anhidrotics are employed to a limited extent either for gen- 
eral conditions, as phthisis, or for local conditions, as hyperi- 
drosis of the hands or feet. Little or nothing is known of the 
effect of drugs on the sebaceous secretion, though iodides and 
some other substances are excreted in the sebum. 

Certain drugs, when taken internally in large doses, produce 
a rash on the skin, possibly because in the course of their ex- 
cretion through the skin they irritate it. Such are — 



(0 Copaiba. 

(2) Cubeb. 

(3) Bromides. 

(4) Iodides. 

(5) Turpentine. 

(6) Belladonna. 

(7) Hydrated chloral. 

(8) Opium. 

(9) Quinine. 

(10) Salicylic acid. 



(11) Arsenical salts. 

(12) Acetanilide. 

(13) Antipyrine. 

(14) Phenacetine. 

(15) Chloralamide. 

(16) Antitoxins. 

(17) Serums. 

(18) Silver salts may discolor 

the skin. 

(19) Sulphonal. 



The following quite rarely produce an eruption : 



(1) Iron. 

(2) Strychnine. 

(3) Creosote. 

(4) Mercury. 

(5) Veratrum. 



(6) Digitalis. 

(7) Sulphur. 

(8) Antimony. 

(9) Santonin. 
(10) Cod liver oil. 



Diaphoretics. 
PILOCARPUS. 

1. PILOCARPUS.— Pilocarpus. (Jaborandi.) Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Pilocarpi. — Fluidextract of Pilocarpus. 
Dose, 2 c.c; 30 tt\,. 

2. PILOCARPINE HYDROCHLORIDUM.— Pilocarpine Hydro- 
chloride. Dose, 0.010 gm. (10 milligm.); y 5 gr. 



pilocarpus. 497 

3. PILOCARPINE NITRAS.— Pilocarpine Nitrate. Dose, 0.010 
gm. (10 milligm.) ; y 5 gr. 

Action of Pilocarpus. 

External. — None. 

Internal. G 'astro-intestinal Tract. — Pilocarpine, which is 
promptly absorbed, is a glandular stimulant of extraordinary 
power. Its first effect is seen in a marked increase of the 
saliva, which contains an abundance of salts and ptyalin, and 
will readily convert starch into sugar. There is a feeling of 
warmth in the mouth, and often a sensation of tenseness about 
the salivary glands. The seat of the stimulation is the termina- 
tions of the secretory nerves. That it does not reside in the 
cells is shown by the fact that the action of the drug is instantly 
antagonized by atropine, which acts upon the nervous struc- 
tures alone, and not upon the secretory cells ; and that it is not 
central in character is evident from the fact that section of 
the secretory nerves does not materially alter the action. 
Nausea, retching and vomiting are occasionally observed, and 
there is always some increase in the gastric and pancreatic 
secretions. Whether there is any increase in the intestinal 
secretion is still unsettled, though this seems highly probable. 
Peristalsis is increased by the contraction of the intestinal 
muscle from the stimulation of its peripheral nervous apparatus. 
Unstriped muscle generally, with the exception of that of the 
blood-vessels, appears to be thrown into contraction, but this 
action is more marked in the bowel than elsewhere; so that 
repeated diarrhceic evacuations occur, accompanied with more 
or less colic. This muscular action also takes place inde- 
pendently of the central nervous system, and is antagonized by 
atropine in the same way as the effect on the glandular secre- 
tions. The secretion of bile is not directly affected. 

Eye. — Myosis (contraction of the pupil) and spasm of accom- 
modation are produced through stimulation of the motor oculi 
terminations. The intra-ocular tension is reduced, after a tem- 
porary increase; myosis being generally attended with lowered 
tension. 
33 



498 PHARMACOLOGY AND THERAPEUTICS. 

Skin. — Shortly after the augmentation of the salivary secre- 
tion begins, there follow a flow of tears and excessive perspira- 
tion. The effect on the sweat glands is so pronounced as to 
leave no question that pilocarpus is the most efficient diaphoretic 
of all known drugs. The general increase in the secretions is 
found to be mainly due to water. Although the solids are in- 
creased also, yet, owing to the excess of fluid poured out, their 
percentage is diminished. After a single subcutaneous dose of 
pilocarpine the water lost in the sweat, saliva, mucus, and other 
secretions may amount to 3785 c.c. (1 gallon). The loss of 
weight is naturally very great also, and this has been set down 
at from 2 to 4 kilogrammes (4J/2 to 9 pounds). The mucous 
glands of the mouth, throat, nose and deeper respiratory pas- 
sages, as well as the ceruminous glands of the ears, all partici- 
pate in the activity induced by the pilocarpine stimulation. The 
effect upon the secretion of milk is doubtful. Under a course 
of pilocarpus the hair grows more luxuriantly, but it becomes 
quite coarse. 

Circulation. — In man pilocarpine is found to give a marked 
acceleration to the pulse, with increased blood-pressure and later 
with arhythmia. This is attributed to vagus paralysis, though 
the rise of blood-pressure is believed to be partly due to a 
stimulation of the vaso-motor centres. Under large doses there 
follow muscular slowing and weakening of the heart, with fall 
of blood-pressure; and this action is judged to be on the cardiac 
muscle directly. In rabbits, it is stated, there is a primary 
vagus stimulation, which is shown by slowing of the heart and 
fall of blood-pressure, and this action sometimes occurs in 
man also. The increased activity of the glands is accom- 
panied by an acceleration of the blood current through them, 
with dilatation of the vessels, and this is believed to be probably 
not due to the direct action of the drug on the latter, but simply 
a result of the stimulus imparted to the glands. After pilo- 
carpine there is frequently noticed a redness of the skin, espe- 
cially of the face, and this is no doubt due to the vascular dila- 
tation accompanying the increased activity of the sweat glands. 



pilocarpus. 499 

The sugar of the blood has been found increased, a result 
attributed to the action of pilocarpine on the terminations of 
the nerves in the liver which regulate the glycogenic function 
of that organ. 

Respiration. — The respiration is often quick and dyspnoeic, 
and rales may be heard over the bronchi, denoting an accumu- 
lation of mucus in them ; the bronchial secretion being markedly 
augmented. The effect on the respiration of ordinary doses is 
merely an indirect one, resulting from changes in the circula- 
tion which diminish the amount of blood passing through the 
lungs and tend to produce asphyxial dyspnoea. 

Central Nervous System. — In experiments on animals it is 
found that the action here is weak and appears late; being en- 
tirely overshadowed by the peripheral actions. It is described as 
follows : The effects are mainly depressing. Vasomotor paraly- 
sis is a rather early and prominent symptom; it leads to dyspnoea. 
Later, the respiratory centre is also depressed. (Edema of the 
lungs (consisting rather in the aspiration of bronchial effusion 
than in a true serous effusion), consequent on the weakened 
heart and obstruction of the bronchi by mucus, is a frequent 
occurrence. The motor centres, especially those of the cord, 
show some stimulation (increased reflexes, tremors, convul- 
sions), and later paralysis. 

Urinary Organs. — The urine, like the bile, does not seem to 
be affected directly, although it may be reduced in quantity 
or otherwise modified by the withdrawal of a large amount of 
fluid from the body by the sweat and other secretions. The 
bladder muscle participates in the general contraction of un- 
striped muscular fibre induced by the drug, and repeated evacua- 
tion and straining may occur. Pilocarpine is excreted un- 
changed in the urine. 

Uterus. — The spleen and bronchi contract under the influence 
of pilocarpine upon unstriped muscle, and the uterus is sup- 
posed to be affected in the same manner. In occasional in- 
stances abortion has been attributed to the action of the drug. 

Temperature. — In consequence of the hyperaemia of the skin 



500 PHARMACOLOGY AND THERAPEUTICS. 

the temperature is apt to be temporarily elevated, but there 
soon follows a decided fall, which is apparently due in great 
measure to the evaporation of the perspiration. The decline in 
body-heat is maintained on an average for about four and a 
half hours. 

The most important effects of pilocarpine on the system are 
the diaphoresis, the salivation, and the myosis. The antagonism 
to atropine is complete with both glands and muscles. The 
alkaloid pilocarpine is more generally employed than pilocarpus 
itself, as it is more prompt and efficient in its action, as well as 
less liable to disagree with the stomach. Children usually bear 
large doses of it well. 

Jaborine, having an action like that of atropine, opposes the 
effects of pilocarpine, but although the amount of it varies in 
different specimens of pilocarpus leaves, there is never a suffi- 
cient quantity to entirely overcome the action of the principal 
alkaloid of the drug. 

Therapeutics of Pilocarpine. 

External. — For promoting the growth of the hair an oint- 
ment composed of pilocarpine hydrochloride, I ; petrolatum, 
60 ; lanolin, 60 ; may be used, or a lotion : Pilocarpine hydro- 
chloride, 1; quinine hydrochloride, 4; glycerin, 60; rose water, 
180. The following, applied with friction, is more stimulating 
to the scalp: Fluidextract of pilocarpus, 15; soap liniment, 15; 
perfumed spirit (not now official), 60. Pilocarpus and its 
preparations also have the effect of rendering the hair darker 
in color. The fluidextract has been employed as a local appli- 
cation in eczema and erysipelas. Pilocarpine is used topically 
as a myotic in many eye affections. Lozenges containing .001 
gm. ( ¥ ^-gr.) are said to relieve dryness of the throat. 

Internal. — Pilocarpine may be used whenever a prompt dia- 
phoretic effect is desired. It is most commonly employed to 
produce sweating in cases of Bright's disease. The usual prac- 
tice is to administer .01 gm. (*. gr.), or more, of pilocarpine 
hydrochloride, in the evening, aiding the sweating by wrapping 
the patient, who should be naked, in warm blankets, applying 



PILOCARPUS. 501 

heat to the feet, and administering hot drinks. As soon as the 
sweating has ceased he should be rubbed dry and left in a dry 
blanket. In this affection the drug is often of great service by 
relieving the strain on the kidneys, by eliminating toxins from 
the blood and diminishing the inflammatory condition in the 
kidneys by lowering the blood-pressure. On account of its 
depressing action on the heart, it should always be used with 
great caution when there is any cardiac disease present, and 
alcohol or strychnine may often be administered with advan- 
tage to guard against depression of that organ. By some, pilo- 
carpine is never employed in chronic parenchymatous nephritis, 
and the opinion is held generally that it is contra-indicated in 
the nephritis of middle or advanced age associated with cardiac 
changes. Theoretically it is the most prompt and efficient 
remedy at our disposal in uraemia, and in many instances it is 
practically of great service. In dropsy due to organic disease 
of the heart it is generally too depressing, and fatal results may 
attend its use. It may be used in pleurisy with effusion, but is 
not so efficient as some other remedies. Injected subcutaneously 
every second day, it has proved successful in the treatment of 
some cases of catarrhal jaundice of a persistent type. Its ad- 
ministration by the same method has been highly recommended 
as a preventive and curative measure in the early stages of 
erysipelas, and has been found effective in cases of obstinate 
aural vertigo. Deafness resulting from disease of the auditory 
nerve or its terminations is sometimes relieved by pilocarpine, 
and the drug is often given internally for deafness due to otitis 
media sicca. Locally applied, pilocarpine is of service as an 
ocular tonic to relieve pain after excessive use of the eyes, and 
in small doses internally has been shown to be a good remedy in 
tobacco and alcoholic amblyopia. Among other diseases of 
the eye in which it has been employed are detachment of the 
retina, chronic iritis, keratitis, haemorrhages into the vitreous, 
haemorrhages and exudations of the retina, glaucoma, atrophic 
choroiditis, and commencing atrophy of the optic nerve. When 
given hypodermatically it is sometimes successful in stopping 



502 PHARMACOLOGY AND THERAPEUTICS. 

hiccough, and also in arresting paroxysms of spasmodic asthma. 
Efficient aid to the action of iodides and mercurials in the re- 
moval of exudations has been found to be rendered by the 
use of pilocarpine or pilocarpus, which is here given chiefly 
for the purpose of increasing the rate at which the exudates 
liquefied by the agents mentioned are taken up and excreted. 
In the case of gummata it is advised that the adjuvant remedy 
should be exhibited once or twice a day. For the attempted re- 
moval of inflammatory deposits such as those met with in 
chronic pneumonia and chronic pleurisy, it is thought prefer- 
able to give pilocarpine for three or four days at a time, and 
then to discontinue its use until the following week. The 
dosage and frequency of administration must be regulated by 
the degree of action, and an amount which will cause but little 
sweating and salivation is said to suffice. In subacute and mus- 
cular rheumatism, as well as in dry and scaly skin eruptions, 
it may often be used with great advantage. Injected subcu- 
taneously, pilocarpine is sometimes successfully employed as an 
antidote in belladonna or atropine poisoning. 

TOXICOLOGY. 

Death very rarely results from the use of pilocarpus or its alkaloid. 
When it does occur, it is by paralysis of the heart or oedema of the 
lungs. Treatment. — Atropine is a physiological antidote. In addition 
to its use, the general treatment of alkaloidal poisoning is called for. 

ANTIMONY. 

ANTIMONII ET POTASSII TARTRAS.— Antimony and Potas- 
sium Tartrate. (Tartar Emetic. Tartarated Antimony.) Dose (ex- 
pectorant), 0.005 gm. (5 milligm.); 1 gr.; (emetic) 0.030 gr. (30 

Preparations. 

1. Vinum Antimonii. — Wine of Antimony. Dose, 1 c.c; 

15 m.. 

2. Syrupus Scillae Compositus. — Compound Syrup of Squill. 
(Hive Syrup.) Dose, 2 C.C.; 30 111. 



ANTIMONY. 503 

Unofficial Preparations. 

1. Antimonii Sulphidum (U. S. P., 1890). — Antimony Sul- 
phide. 

2. Antimonii Sulphidum Purification (U. S. P., 1890).— 
Purified Antimony Sulphide. (Purified Black Antimony.) 

3. Antimonium Sulphuratum (U. S. P., 1890). — Sulphurated 
Antimony. (Kermes mineral.) Dose, 0.01 to 0.05 gm.; % to 
1 gr. 

4. Pilulae Antimonii Composite (U. S. P., 1890). — Com- 
pound Pills of Antimony. (Plummer's Pills.) Dose, 1 to 3 
pills. 

5. Antimonii Oxidum (U. S. P., 1890). — Antimony Oxide. 
Dose, 0.05 to 0.25 gm.; 1 to 4 gr. 

6. Pulvis Antimonialis (U. S. P., 1890). — Antimonial Pow- 
der. (James' Powder.) Dose, 0.15 to 1 gm.; 3 to 15 gr. 

Action of Salts of Antimony. 

External. — They are powerful local irritants. Tartar emetic 
produces a pustular eruption on the skin, and the Liquor Anti- 
monii Chloridi of the B. P., which is a solution of antimony 
chloride in hydrochloric acid, is a severe caustic. 

Internal. Alimentary Canal. — Antimony acts very much like 
arsenic, though differing from the latter in the severity of its 
local action and in being absorbed more slowly. In large doses 
by the mouth, or if injected into the circulation, its effects are 
found to be practically identical with those of arsenic, but 
vomiting is always a prominent symptom, the poison being 
rapidly excreted into the alimentary canal. The only result of 
very small doses of tartar emetic is the production of some 
perspiration. In somewhat larger amounts, by its direct action 
on the walls of the stomach, it causes nausea and vomiting with 
marked prostration and the usual accompaniments of emesis, 
such as salivation, sweating and quickened pulse. Like other 
antimonial preparations, it is irritant to the intestine if given 
in sufficient quantity. (A round mass of metallic antimony 
was formerly known as the " family pill," because it could be 



504 PHARMACOLOGY AND THERAPEUTICS. 

repeatedly used as a laxative.) In poisonous doses tartar 
emetic gives rise to violent and continuous vomiting, the vomit, 
after the ordinary contents of the stomach have been evacuated, 
consisting of slimy mucus, which eventually may have blood 
mixed with it. With the vomiting are associated profuse 
watery diarrhoea, great muscular weakness, and collapse, with 
cold perspiration, clammy skin, and cyanosis of the face and 
extremities. This drug when thrown directly into the blood 
also produces vomiting, but it is found that much larger quan- 
tities are required for this than when it is given by the mouth. 
Moreover, a portion of the antimony which is injected intra- 
venously is carried to the stomach and intestine, where it causes 
local irritation. Some have believed that the emesis is due 
to action on the medulla, but from the facts just mentioned it 
would appear that this is attributable entirely to its effects as 
a gastric irritant. It is true that, when injected into the circu- 
lation, it may have an emetic effect even if the stomach is 
replaced by a bladder, as has been shown by experiment; but in 
explanation of this it has been suggested that although the 
antimony cannot act on the stomach under these circumstances, 
it may induce vomiting by causing irritation of some other 
part of the alimentary tract. While large quantities affect the 
gastro-intestinal tract much in the same way as arsenic, caus- 
ing hyperemia and swelling of the mucous membrane, medicinal 
doses do not cause any such effects. Even with large doses, 
however, the intestine may remain unaffected, both because 
antimony is, as has been mentioned, absorbed more slowly than 
arsenic, and because the larger portion of the poison is usually 
gotten rid of by the violent vomiting excited. 

Heart and Circulation. — Antimony is a direct depressant to 
the cardiac muscle. The temporary acceleration of the pulse 
is simply one of the effects of the vomiting, and is succeeded 
by a diminution in both the frequency and force of the beat 
of the heart. The final stoppage of the organ is found by ex- 
periment to take place in diastole. There is no evidence that 
the cardiac nerves are affected. There is a continuous fall in 



ANTIMCNY. 505 

blood-pressure, due in some measure to the weakness of the 
heart, but principally to the effect of the drug on some part of 
the vaso-motor system. The peripheral nerves and muscle of 
the vessels are known to be implicated, though it is uncertain 
whether or not the vaso-motor centre shares in the action. 

Respiration. — Like the pulse, the respiration is often quick- 
ened at first, and may be shallow and irregular from the nausea, 
but in cases of poisoning it becomes slow and labored, and 
eventually ceases along with the heart. The weakening of this 
function is believed to be chiefly due to the disturbance of the 
circulation and the irritation of the alimentary canal, though 
the respiratory centre may possibly be in some degree directly 
acted upon. 

Nervous and Muscular Systems. — In the frog the central ner- 
vous system has been shown to be directly depressed by anti- 
mony. This is thought to be probably the case in mammals also, 
though the effects of the poison on the circulation and alimen- 
tary canal render the true nature of the nervous action obscure. 
There is good authority for stating that the depression and 
collapse resulting from the drug are due to the gastric irritation 
and slowed circulation, and not to any involvement of the per- 
ipheral nerves and muscles, as has been believed by some. In 
the frog the voluntary muscular tissue is found to be weakened 
to some extent, but only after large doses and at a late stage 
of the poisoning. 

Temperature. — Antimony, in considerable doses, produces a 
marked reduction of temperature, the fall being stated to some- 
times amount to 6° C. (42. 8° F.) in animals in the course of 
a few hours. This is attributed to the slowness of the circula- 
tion, the general depression and collapse, and the profuse 
sweating. 

Secretion and Excretion. — Such secretions as the sweat, the 
saliva, and the mucus of the respiratory tract are increased by 
antimony, not in consequence of any direct action upon the 
glands, but simply as a result of the emesis caused by the drug. 
Its action on the urinary secretion is not very marked. The 



506 PHARMACOLOGY AND THERAPEUTICS. 

urine is sometimes more or less increased, and sometimes dimin- 
ished or even entirely suppressed. This has been explained by 
the suggestion that there is a temporary stimulation of the renal 
epithelium, but that later, when a larger amount of the anti- 
mony has been absorbed, an acute irritation of the kidneys is 
excited. The prolonged use of the drug, as in the case of 
arsenic, is liable to induce fatty degeneration of many organs 
and abrogation of the glycogenic function of the liver, while the 
nitrogen of the urine is increased. Very small quantities of anti- 
mony, given repeatedly, are stated, however, to augment the 
hepatic glycogen and fat, without apparently altering the nitro- 
gen of the urine. Antimony is absorbed from the gastro- 
intestinal tract and very slowly from the skin, and it passes into 
the tissues much more gradually than arsenic; consequently 
doses can be chosen whose only action is to produce nausea, 
or, if somewhat larger, vomiting. After absorption it is stored 
in considerable amount in the liver. It is excreted into the 
stomach and intestine, in the urine, and also probably in the bile 
and milk. 

Therapeutics of Salts of Antimony. 

External. — A solution of antimony chloride, known as Butter 
of Antimony, was once used as a caustic, but its employment has 
been abandoned, as the sore produced is difficult to heal. An 
ointment of tartar emetic which was formerly employed as a 
counter-irritant has also fallen into disuse, as its application 
causes considerable pain. If tartar emetic is persistently rubbed 
on the skin, the pustules caused by it may become confluent and 
form small abscesses, and, later, extensive necrosis and ulcera- 
tion of the integument may be induced. 

Internal. — Tartar emetic was at one time given in a large 
number of conditions which it is unnecessary to enumerate, as, 
on account of its depressing effects, it has been superseded by 
other remedies. Almost the only class of affections in which 
it is now employed to any extent is diseases of the respiratory 
passages, in which it has a limited field of usefulness. In com- 
mencing bronchitis it is occasionally given until vomiting 



ANTIMONY. 507 

occurs, and then continued in smaller doses and at longer in- 
tervals. More commonly, in the early stage of acute bronchitis, 
it is used in doses insufficient to produce emesis. Here it serves 
to promote secretion, diminish fever, induce diaphoresis, and 
hasten the elimination of inflammatory products. When a free 
secretion of bronchial mucus has once been established, it 
should as a rule be discontinued, as after that it is too de- 
pressing to constitute a satisfactory expectorant. It is also a 
useful remedy in the first stage of acute nasal and pharyngeal 
catarrh. It is not a suitable preparation for infants or very 
young children, and compound syrup of squill (Coxe's hive 
syrup), which is a domestic remedy for croup, has been known 
to prove fatal. When an emetic is required in laryngitis, bron- 
chitis, or other acute inflammation of the respiratory tract, 
ipecacuanha is usually preferable. In acute inflammatory and 
febrile diseases, other than those of the air-passages (provided 
there is not much irritability of the stomach), minute doses of 
tartar emetic (.004 gm. ; J^ gr.) are still highly spoken of by 
some writers, and impending attacks of malarial fever are said 
to be sometimes successfully aborted by emetic doses of anti- 
mony and ipecacuanha. As a diaphoretic tartar emetic has 
been very largely supplanted by pilocarpine. 

TOXICOLOGY. 

Acute Poisoning. — The symptoms resemble those of arsenical poison- 
ing (see p. 247). Post-mortem. — There is hyperemia, tumefaction and 
erosion, with ecchymoses, of the gastric and intestinal mucous mem- 
branes. Pustules may be found in the mouth, oesophagus, stomach and 
small intestine, and there may be congestion or inflammation of the 
lungs. 

Treatment. — Emetics are seldom required, but if the poison does not 
cause free vomiting, the stomach should be washed out or emetics ad- 
ministered subcutaneously (apomorphine hydrochloride) or by the mouth 
(zinc sulphate). A purge may also be given to remove the poison in 
the bowel. Tannic acid, in repeated doses of 2 gm. (]/ 2 dr.), is used 
to precipitate the antimony in the stomach, and the tannate thus formed 
should be washed out. A form of tannic acid which is usually readily 



5<d8 pharmacology and therapeutics. 

obtainable is strong tea, which is also serviceable as a stimulant for 
the collapse. Mucilaginous drinks may likewise be given freely, and 
stimulants by hypodermatic injection, as well as the external applica- 
tion of heat, are generally called for. 

Chronic Poisoning is very rare, and it is difficult to recognize, as 
the symptoms do not present any very definite characteristics. Among 
them are described headache, dizziness, depression, indistinct sight, 
nausea and vomiting, dyspepsia with more or less gastric pain, diar- 
rhoea, loss of flesh, albuminuria, general weakness and exhaustion, and 
finally collapse. As the symptoms resemble those of acute gastrointesti- 
nal catarrh, poisoning with small, repeated doses of antimony is some- 
times resorted to criminally, and an instance of the use of the drug for 
homicidal purposes has recently been the subject of judicial inquiry. 
Pustular eruptions, it is said, have been observed from the prolonged 
internal use of tartar emetic. 

Post-mortem. — Antimony is said to be found in the liver, kidneys, 
spleen, bones and muscles, and there is also fatty degeneration of the 
viscera, especially the liver. 

THOROUGHWORT. 

EUPATORIUM.— Eupatorium. (Thoroughwort. Boneset.) Dose, 
2 gm.; 30 gr. 

Preparation. 
Fluidextractum Eupatorii. — Fluidextract of Eupatorium. 
Dose, 2 c.c; 30 n\. 

Action of Thoroughwort. 
Thoroughwort is tonic and mildly laxative. It is also dia- 
phoretic in infusion, but the diaphoretic properties of the prep- 
aration are chiefly due to its hot water. 

Therapeutics of Thoroughwort. 
It is, like many other substances of vegetable origin, a do- 
mestic remedy for the commencement of catarrh, influenza, or 
muscular rheumatism. 

MARRUBIUM. 
MARRUBIUM. — Marrubium. (Horehound.) Dose, 2 gm.; 30 gr. 



SUBSTANCES ACTING ON URINARY SYSTEM. 509 

Action of Horehound. 
Horehound, used as a decoction or an infusion, is in moder- 
ate doses diuretic and diaphoretic, and in large doses laxative. 
It is probably also a bitter stomachic. 

Therapeutics of Horehound. 
It may be given to increase the action of the skin and kid- 
neys, but its effects are not marked. Horehound candy, slowly 
dissolved in the mouth, relieves the relaxed throat of public 
speakers. 

Division VI. — Substances Acting on the Urinary System. 
1. Drugs Increasing the Quantity of Urine Secreted. — These 
are called diuretics. The kidneys are susceptible to a variety 
of influences. Thus, anatomically they present two distinct 
varieties of epithelium and have an extremely abundant supply 
of vessels and vaso-motor nerves, while the activity of the 
organs is profoundly affected by variations in the quantity of 
blood flowing through them. In the present state of our 
knowledge it is impossible to say in just what manner many 
diuretics act. A considerable number of them, no doubt, are 
effective in more ways than one, and the following table, taken 
from Brunton but somewhat modified, presents the various 
ways in which these agents probably act: 



5io 



PHARMACOLOGY AND THERAPEUTICS. 









Increased car- 
diac action. 


r Digitalis, 
Caffeine, 
Alcohol, 
Strophanthus, 




Generally. 


4 


General vas- 
cular contrac- 


. Sparteine, 

Erythrophlo3um, 

Digitalis, 

Squill, 


Raise 
arterial < 






tion. 


Convallaria, 






Strychnine, 








Cold to skin. 


pressure. 














. Act on vaso- 


? same as above. 








motor centres. 










Broom, 






,■ Contract 




Caffeine (large 






efferent - 




doses), 






vessels. 


x n •< 


Buchu, 

Uva ursi, 




Locally 




Locally on 
^ kidney. 


Juniper, 
Turpentine, 




^in kidney. 




Copaiba, 






Cantharides. 




Dilate, chiefly 


Caffeine, 




locally, renal - 


Urea. 




^ vessels. 


. 






r Urea, 




r 


Caffeine, 




Increase water excreted. 


Theobromine So- 
dio-salicylate, 
Calomel, 


Act on secreting 




. Colchicum, 


nerves or renal cells. « 




Solution of Potas- 
sium Hydroxide, 




Increase water and solids 


Potassium Acetate, 




excreted. 


Potassium Citrate, 
Potassium Nitrate, 
Sodium Citrate and 






t. 




other salines. 



Therapeutics. — Diuretics are used chiefly for the following 
purposes: (i) To maintain the action of the kidneys. Dimin- 



SUBSTANCES ACTING ON URINARY SYSTEM. 5 I I 

ished urinary excretion may be purely functional in its origin, 
as in fevers. In these it is essential that the action of the kid- 
neys should be maintained, and the free use of water is often 
very serviceable for this purpose. The ingestion of large quan- 
tities of water greatly increases the urinary flow, and may in- 
crease not only the amount, but also the solids, of the urine. 
Investigation has shown that when the tissues are full of the 
products of disintegration the effect of water is very marked, 
but that upon the wasting processes of the body it exerts no 
influence ; hence, while it may not be possible to produce tissue- 
disintegration by water, there would seem to be no question 
that water is capable of washing out the retained products of 
tissue change. This naturally renders it of value in various 
diseases. Intestinal lavage (enteroclysis) with normal saline 
solution, by means of the rectal irrigator, has been found one 
of the best and most certain of diuretics. Diuretics are used 
in cardiac and pulmonary affections when, owing to the general 
vascular disturbance, the quantity of urine becomes diminished. 
In diseased conditions of the kidney itself the maintenance of 
the urinary excretion is urgently demanded, but on account 
of organic changes in the renal secretory structures, it is often 
the case that diuretics fail to produce their appropriate effect. 
In many such conditions it is a question how far it is desirable 
to stimulate the diseased organ, and in the great majority of 
instances only the mildest diuretics should be prescribed. When 
renal inflammation is present, even if it be chronic, irritating 
diuretics should be avoided. In acute Bright's disease large 
draughts of water at regular intervals not infrequently have 
a very favorable effect; not only greatly increasing the amount 
of urine, but also lessening the irritation of the kidneys. In 
grave cases, with violent irritation of the kidneys and per- 
haps suppression of urine, hypodermoclysis has proved of 
great benefit. (2) To get rid of fluid in various parts of the 
body. For this purpose hydragogue diuretics are employed in 
all forms of dropsy. (3) To diminish irritation of the genito- 
urinary organs, as from the deposit of solids from the urine. 



5 I 2 PHARMACOLOGY AND THERAPEUTICS. 

Here diuretics are of great service by diluting the secretion, 
and the value of water as an adjuvant to medicinal diuretics 
should always be taken advantage of. The alkalies are also of 
special utility. 

In the use of diuretics it is important to have in mind that 
they may act in a variety of ways, and as it is not always pos- 
sible to determine the precise cause of the deficiency in the 
urinary excretion, it is quite customary to prescribe two or 
more of these drugs in combination, in the hope that one of 
them at least may prove effective. 

2. Drugs Diminishing the Quantity of Urine Secreted. — These 
are usually of such a character as to induce acute nephritis 
when given in large doses; e. g., turpentine, cantharides, phos- 
phorus. Exalgin also is reputed to diminish the quantity of 
urine. They are never given for this purpose in medicine. 

3. Drugs Rendering the Urine Acid. — Urotropin is the most 
reliable remedy to render an alkaline urine acid. The benzoates 
are also used for this purpose, as benzoic acid during its pas- 
sage through the kidney is converted into hippuric acid, and 
they may be given for alkaline decomposition in the urinary 
passages. The free use of carbonated water increases the 
acidity of the urine. Salicylic acid is capable of slightly in- 
creasing it, and also very large doses of citric and tartaric acids, 
borax, and possibly saccharin. 

4. Drugs which Render the Urine Alkaline. — Some salts of 
the metals potassium, sodium, lithium and calcium will do this, 
e. g., the carbonates, borates and hydroxides; even the tar- 
trates, citrates, malates, lactates, and acetates, since they are 
excreted by the kidney as carbonates. Nitric acid is said to 
increase the amount of ammonia in the urine, and thus to render 
it slightly alkaline. Ammonium salts given internally do not 
render the urine alkaline, because they are decomposed in the 
body, with the formation of urea; they may even increase the 
acidity from the larger amount of nitric acid excreted. 

Antilithics are drugs which tend to prevent the decomposition, 
in the urinary passages, of the solids of the urine. When the 



SUBSTANCES ACTING ON URINARY SYSTEM. 513 

secretion is acid, gravel or uric acid calculus is liable to occur 
from the crystallization of uric acid, or, more rarely, lime oxa- 
late calculus, from the crystallization of lime oxalate. When- 
ever a tendency is shown to the formation of either of these 
calculi, alkalies or other remedies reputed to prevent this should 
be administered. For uric acid the following are chiefly used: 
distilled water, potassium salts, lithium salts, magnesium citro- 
borate, piperazine, lysidine and lycetol. For lime oxalate, dilute 
nitro-hydrochloric acid, carbonated water, and lactic acid (for 
digestion). When, on the other hand, the urine undergoes alka- 
line decomposition, phosphatic calculi are liable to form from 
the crystallization of phosphates. Here the aim must be to 
render the secretion acid and aseptic, and benzoic acid, the 
benzoates, salicylic acid, the salicylates, as well as urotropin or 
other urinary antiseptics, are given for this purpose. Lithon- 
triptics are agents which are supposed to promote the solution 
of calculi, but as a matter of fact, no means has as yet been 
discovered which is capable of dissolving a calculus when once 
formed. It is true that alkalies have been credited, owing to 
their action in the test-tube, with the power to dissolve uric acid 
calculi; but in the body alkalies cannot convert free uric acid 
into soluble alkaline urates, but at most into acid urates, which 
are found to be almost as insoluble as uric acid itself. Hence, 
it is believed, it would be quite impossible to effect in this way 
the solution of even very small calculi. 

Therapeutics. — The chief use of alkalies in this connection is 
to diminish or entirely neutralize acidity of the urine, and thus 
prevent as far as possible the precipitation of uric acid. In this 
way they tend to prevent increase in the size of a stone already 
formed. They are also of service in lessening the irritability 
of the urinary passages. In the case of gouty subjects they are 
prescribed not only to alkalize the blood, but also to alkalize 
the urine, since in such persons the deposition of uric acid in 
the urine is a common occurrence. The citrates and acetates 
are the best forms in which to give the alkalies, as they are not 
apt to interfere with the digestion, and potassium and lithium 
34 



514 PHARMACOLOGY AND THERAPEUTICS. 

citrate and acetate are to be preferred, since these metals form 
more soluble urates than sodium. Copious draughts of water, 
by diluting the urine, aid in the prevention of calculi, and 
natural mineral waters, especially those containing lithium, are 
in very general use. 

5. Drugs Preventing the Urine from Decomposing. — Urine 
retained from any cause in the bladder will undergo alkaline 
decomposition, and the same result is likely to occur from the 
admixture of pus, as from cystitis or pyelitis, with the urine. 
This decomposition of the urine may be prevented by the ad- 
ministration of drugs which in their excretion by the urine 
render it aseptic. Such are — 



(1) Urotropin. 


(6) Cubeb. 


(2) Benzoic acid. 


(7) Oil of Sandal Wood 


(3) Salicylic acid. 


(8) Saccharin. 


(4) Uva Ursi. 


(9) Many volatile oils. 


(5) Copaiba. 


(10) Boric acid. 



6. Drugs Altering the Composition of the Urine. — Almost any 
drug will do this, either because it is excreted in the urine, or 
because it sets up certain changes in the body the products of 
which are excreted in the urine; but it will be sufficient to refer 
to a few striking examples. 

Turpentine, cantharides and salicylic acid in large doses will cause 
hematuria, for the reason that they set up inflammation of the kidney. 

Potassium chlorate, all nitrites, acetanilide, pyrogallic acid, poisoning 
by the mushroom {Helvetia esculenta), and transfusion of blood break 
up red blood-corpuscles, and the products when excreted by the urine 
render it dark. Large doses of mineral acids, arsenic, naphthol and 
naphthalene may occasionally produce the same result. 

Phosphorus in large doses causes leucin and tyrosin to appear in the 
urine, while the urea is greatly increased. 

The saline diuretics increase the solids of the urine. 

The chrysophanic acid in rhubarb and senna makes the urine, if it 
is acid, a brownish color ; if it is alkaline, a purplish red. Logwood 
renders alkaline urine reddish or violet. Santonin colors acid urine 
yellow or greenish-yellow, and alkaline urine, reddish. Phenol, naph- 



SUBSTANCES ACTING ON URINARY SYSTEM. 5 I 5 

thalene, creosote and other preparations of tar, as well as the arbutin 
in uva ursi, chimaphila and gaultheria make it dark greenish-brown. 
Picric acid makes it a bright yellow, and methyl violet a dark blue. 
The urine of persons poisoned with carbonic oxide remains sweet for 
months. 

Poisoning by carbonic oxide, curare, amyl nitrite, and turpentine, and 
sometimes chloroform, camphor, mercury, morphine, hydrocyanic acid, 
sulphuric acid, alcohol, lead compounds, and salicylic acid, lead to the 
appearance in the urine of a body which like sugar reduces Fehling's 
copper solution. In the case of some of these drugs, at least, the urine 
does not contain glucose, but glycuronic acid ; for although it re- 
duces blue copper solutions, it does not undergo alcoholic fermentation 
on the addition of yeast or give the phenyl-hydrazin test. Chloral was 
formerly supposed to induce glycosuria, but this has been shown not to 
be the case, the reducing agent in the urine being urochloralic acid, and 
not sugar. The administration of phloridzin, a glucoside from the 
bark of stems and roots of the apple, pear, plum and cherry, which, when 
continuously heated with dilute mineral acids, is resolved into glucose 
and phloretin, leads to the production of genuine glucose in the urine. 

Some drugs impart a peculiar odor to the urine ; for instance, the 
smell of violets is produced by turpentine and oil of juniper. The 
aromatic odor of cubeb and copaiba can be detected in the urine after 
the administration of these substances. 

Prolonged poisoning by lead often induces chronic nephritis. This is 
usually of the granular type, but in some instances the kidney presents a 
mixture of interstitial and parenchymatous disease. In acute mercurial 
poisoning, when death does not follow in the course of a few hours, 
anuria is not infrequently observed, and this has been found to be due 
to renal changes, the most prominent feature of which is necrosis of 
the epithelium of the tubules. Fatty degeneration of the renal epi- 
thelium may be caused by phosphorus and arsenic. 

7. Drugs Acting on the Bladder and Urethra. — Practically, 
the only ones of value are sedatives to the urinary tract. 

If the urine shows a tendency to decompose, the drugs which prevent 
decomposition, and if the urine is excessively acid, alkalies, act as 
urinary sedatives. Other sedatives are opium, belladonna, hyoscyamus, 
pareira, buchu and uva ursi, which are direct sedatives to the vesical 
and urethral mucous membrane. 

Urinary sedatives are used very largely in cases of cystitis and 
urethritis, whatever the cause may be. Local astringent and antiseptic 
injections are also employed. 



5 l6 PHARMACOLOGY AND THERAPEUTICS. 

A. Diuretics. 

WATER. 

1. AQUA.— Water. 

2. AQUA DESTILLATA.— Distilled Water. 

Action of Water. 

External.— An indifferent bath (31. i° to 36.6 C— 88° to 98 
F.), or one in which there is experienced a sensation of neither 
heat or cold, produces no particular effect. 

In a healthy individual a cold bath causes at first a feeling 
of extreme chilliness, the teeth chatter, and the extremities are 
blue and covered with cutis anscrina. This is because the blood 
is driven away from the surface, which is consequently left 
cold. The abstraction of heat lowers the bodily temperature, 
as the calorific centres are not able to produce all the heat re- 
quired for the preservation of the normal temperature. Very 
shortly, however, reaction sets in; the extremities grow warm, 
the pulse grows stronger and more rapid, and the respiration, 
which was at first gasping, becomes full and regular. Every 
portion of the body now receives a more perfect supply of 
blood, and a general feeling of exhilaration is experienced, 
which, if the bath is left at this stage, often remains for many 
hours. This action is explained by the fact that cold always 
contracts the blood-vessels and reflexly stimulates the vital 
centres to increased activity. If the bath is unduly prolonged, 
the system suffers from the effects of over-stimulation, with 
more or less profound depression of the nervous system and 
circulation, and consequent interference with functional activity. 
The proper duration and temperature of the cold bath differs 
very greatly for different individuals. The daily use of a suit- 
ably regulated cold bath no doubt diminishes the liability to 
catch cold. 

Warm baths cause flushing of the skin and have the effect 
of accelerating the pulse and respiration. They have a tend- 
ency to raise the temperature of the body by imparting heat to 



WATER. 5 I 7 

it and preventing loss of warmth from it. After the bath pro- 
fuse perspiration results, while the excretion of urine is dimin- 
ished. Owing to the dilatation of the cutaneous vessels caused 
by warm baths, the blood is withdrawn to a considerable extent 
from the internal organs, and in consequence of this their func- 
tional activity is lessened. 

Water is not absorbed into the circulation through the skin 
in mammals. It has been ascertained that when it is absorbed 
into the red blood-corpuscles outside the body, some obscure 
change takes place in the latter, and the haemoglobin diffuses 
into the surrounding fluid. 

Internal. — Water if swallowed in sufficient quantities washes 
out the tissues and increases the flow of urine. Taken habitu- 
ally thus, it somewhat augments the excretion of urea, while 
the amount of uric acid is said to be diminished. It has been 
supposed to have considerable effect in promoting tissue meta- 
morphosis, through the increased movement of the lymph flush- 
ing out the cells and leading to a more complete removal of 
the waste products. It does indeed have some such action, but 
this is not as pronounced as is thought by many, as the increase 
in the nitrogen and sulphur eliminated in the urine has been 
found to amount to only 5 per cent., or less. Lukewarm water, 
as is well known, will cause nausea and vomiting, while hot 
water, in small amounts frequently repeated, is often, very 
useful in controlling irritability of the stomach. 

Therapeutics of Water. 
External. — Cold baths are used for the subsequent exhila- 
rating effects, which may be increased by brisk rubbing with 
a rough towel, but persons whose systems do not promptly react 
afterward should not resort to them. Cold salt baths, particu- 
larly if they are sea baths, are more stimulating than fresh- 
water bathing. The use of a cold bath is popularly supposed 
to be dangerous to the over-heated, but persons with healthy 
circulations find nothing so refreshing and so preventive of 
muscular stiffness after severe exercise and sweating: as a brief 



5 l8 PHARMACOLOGY AND THERAPEUTICS. 

cold plunge- or shower-bath. Cold baths at the present time 
are very largely employed in the treatment of febrile diseases, 
more particularly typhoid fever. Vogel's statistics of typhoid 
at the Military Hospital in Munich, covering a period of fifty 
years, show a' reduction of mortality from 20 per cent., under 
other methods, to 2.07 per cent, under what is known as the 
Brand treatment. The latter consists in the use of water at 
about 21.1 C. (70 F.), for fifteen minutes every three or four 
hours, when the rectal temperature is at or above 39.4 C. 
(103 F.). In applying the method, the temperature of the 
bath is made at first about 29. 4 C. (85 F.), and in each suc- 
cessive bath the temperature is lowered 2.8 C. (5 F.), until 
18. 3 C. (65 F.) is reached. Sometimes a bath is employed at 
a temperature 5.5 C. (io° F.) below that of the patient, and 
the water is then cooled by adding cold water or ice until it 
falls to a temperature of about 20 C. (68° F.). In these baths 
the patient is lowered into the tub by means of a sheet, and on 
being lifted back into bed is carefully dried without rubbing 
and left covered with a sheet or blanket. Brisk rubbing of the 
whole body should be carried out during the bath, and the feet 
kept warm. Cold baths are no longer used in the treatment of 
typhoid fever with the notion that they simply reduce tempera- 
ture. They are useful for the stimulation of the nervous system 
which they effect to a greater or less degree, and for the 
marked diuresis which they produce, thus, supposedly, favoring 
the elimination of toxins by the urine. If for any reason the 
use of the cold bath is impracticable or unadvisable, various 
substitutes for this may be resorted to, such as sponging, 
affusion, or the cold pack. The latter consists of a sheet, four 
folds thick, wrung out in cold water and wrapped around the 
naked body for five or ten minutes at a time. Affusions were 
employed as long ago as 1795 by Currie, and in the form known 
as "slush baths" were used with excellent effect among our 
troops in the Spanish-American war. Rubbing the surface with 
pieces of ice is also sometimes practiced. In pneumonia the 
cold bath is occasionally used, when the fever fs high, but cold 



WATER. 5 I 9 

is more commonly applied by means of powdered ice, which, 
confined in rubber tissue, is placed in a flannel bag and bound 
to the chest over a layer of lint. Cold baths are also sometimes 
of service in entero-colitis and in acute rheumatism with high 
fever, and they undoubtedly constitute the best treatment for 
any sudden hyperpyrexia. Thus, ice-water baths are of the 
greatest possible service in sunstroke, or thermic fever, care 
being taken that friction of the skin is at the same time em- 
ployed, in order to bring the hot blood to the surface and pre- 
vent congestions. Cold water may also be injected into the 
bowel in cases where the skin is cold but the central tempera- 
ture very high. The application of ice-bags or of the cold 
water coil to various parts of the body is used for the purpose 
of controlling inflammatory action and sometimes also for the 
haemostatic effect of the cold, as in pulmonary haemorrhage, by 
its vaso-constricting action. 

In nocturnal seminal emissions the submerging of the scro- 
tum in a tumbler of cold water, or the dashing or sopping of 
cold water against the perineum, scrotum and lumbar region, 
is not infrequently found beneficial. A very useful practice in 
dysentery is the gentle injection into the bowel of considerable 
quantities of cold water, and the use of a moderately forcible 
stream of water of varying temperature is highly esteemed by 
some physicians in the treatment of a number of affections of 
the rectum, anus, and genito-urinary apparatus. Among these 
may be mentioned haemorrhoids, internal and external, prolapsus 
ani, slight cases of prolapsus recti, pruritus ani and vulvae, 
eczema of the margin of the anus, vaginitis, varicocele, chronic 
prostatitis, and atonic impotence in the male. In these various 
troubles the application is made by means of a bidet, which, it 
is advised, should be attached to the water-closet seat habitually 
used by the patient. The bidet pipe should be movable by means 
of a handle, so that the stream can be directed wherever de- 
sired, and it should also have connection with the hot and cold 
water-supply of the house. 

A cold bath is one the temperature of which is below 21 ° C. 



520 PHARMACOLOGY AND THERAPEUTICS. 

(yo° F.), and a hot bath one with a temperature above 36.6 C. 
(98 F.). Anything between 31. i° and 36.6 C. (88° and 
98 F.) is often spoken of as a warm bath, though it is really 
indifferent, and should more properly be called tepid. Hot 
baths, as they have the effect of liquefying the fatty secretions, 
are naturally more cleansing than cold. Like the application 
of heat in other forms, they soothe pain, and they are useful 
in alleviating muscular and mental fatigue and various in- 
flammatory conditions. ' They also serve to relieve muscular 
spasm, as well as internal congestion, by withdrawing blood 
from the internal organs to the surface, and often prove of 
great value in colic, spasmodic stricture of the urethra, laryn- 
geal spasm, infantile convulsions, etc. Hot baths and the hot 
pack are useful in renal disease and uraemia and in commencing 
colds, on account of the free diaphoresis which they induce ; and 
after a hot bath the patient should be immediately wrapped in 
warm blankets and put to bed. in order to prevent contraction 
of the cutaneous blood-vessels and arrest of perspiration. A 
hot bath at bedtime is not infrequently of service in insomnia, 
and in many asylums for the insane it is customary to give a 
bath of the temperature of 40 C. (104 F.) as a remedy for this 
condition. The hot vapor, or Russian, bath is employed for 
many of the same purposes as the hot air, or Turkish, bath, and 
particularly when the skin or kidneys are inactive, but is not so 
generally useful, as no evaporation of perspiration can take 
place during the bath. A valuable method for using the hot 
vapor bath in a mild form is the "bronchitis tent," which con- 
sists of a bed canopy made by sheets, into which the steam 
arising from a steam sterilizer is introduced by means of a 
tube. While equally efficacious in the first stage of bronchitis 
in adults, it is more conveniently employed in the case of chil- 
dren on account of the size of the bed. 

Localized hot baths act in the same way as general ones, but 
are less pronounced in their effects. A hot sitz bath causes dila- 
tation of the vessels of the pelvic viscera and a hot foot bath 
of proper depth, dilatation of the branches of the femoral and 



WATER. 5 2 I 

probably of the iliac arteries. Mustard is often added to in- 
crease their effect, and both these forms are much used in 
amenorrhcea. The sitz bath is more particularly suited to spas- 
modic dysmenorrhea, and the foot bath is commonly employed 
in the first stage of a cold. In gonorrhoea a hot sitz bath is a 
good prophylactic against c-hordee, and steeping the penis in hot 
water is a widely used remedy for this painful affection when 
it does occur. In spasmodic croup benefit may.be derived from 
the application to the neck of a hot compress made from 
spongiopiline wet with hot water, or from several layers of 
flannel wrung out of water and covered with cotton and oiled 
silk. In various painful inflammatory and other affections of 
the eyes much relief may be derived from the use of hot water 
applied by cotton pledgets, frequently renewed, or allowed to 
drop continuously upon the eye from a fountain syringe. Irri- 
gation with plain hot water, or with normal saline solution 
(see Sodium Chloride) has proved of great service in markedly 
lessening tenesmus in acute dysentery. Enteroclysis is now 
also employed with advantage in a variety of other conditions, 
among which may be mentioned shock, nephritis, especially 
acute uraemia, auto-infection from retention of putrid contents 
in the intestine, cholera infantum, toxaemia in fevers, particu- 
lary typhoid, septic endocarditis and septic conditions generally, 
pelvic and genito-urinary inflammations, and haemorrhage in 
the rectum or adjacent organs. Such antiseptics or other medi- 
caments as seem to be indicated are often added to the irriga- 
tion fluid. 

Internal. — Water is principally used to wash out the tissues 
and for its supposed effect upon tissue metamorphosis and the 
excretions. It is of great service in keeping the urine diluted. 
By its free use the liability to the formation of gall-stones may 
be diminished, in consequence of its effect in increasing the 
watery secretion of bile, so that the bile becomes less concen- 
trated and flows more freely. The liability to the formation 
of gravel or urinary calculi is also lessened, as the crystals com- 
posing such calculi are washed out of the urinary tract before 



522 PHARMACOLOGY AND THERAPEUTICS. 

an opportunity is afforded them of forming in aggregations of 
any size, while if they consist of uric acid, the habitual use 
of a sufficient quantity of water, as has been mentioned, tends 
to diminish the excretion of that substance. When large 
amounts of water are taken, pure distilled water should be 
used, and it should be drunk for the most part between meals. 
One or more glasses of cold water swallowed upon rising has 
the effect in some individuals of causing an evacuation of the 
bowels. Tepid water, to which mustard is often added, is 
very commonly used as an emetic. In a work of this kind the 
natural mineral waters employed for baths and internal medic- 
inal use can be only incidentally alluded to as their principal 
solid ingredients from time to time come under consideration. 
For more extended information in regard to them reference 
must be had to the special treatises on physical therapeutics. 

BROOM. 

1. SCOPARIUS. — Scoparius. (Broom.) Dose, 1 gm.; 15 gr. 

2. SPARTEINE SULPHAS.— Sparteine Sulphate. Dose, 0.010 
gm.; y 5 gr. 

JJnfRcxal Preparation. 
Extractum Scoparii Fluidum (U. S. P., 1890). — Fluidextract 
of Scoparius. Dose, 1 to 4 c.c; y 4 to 1 fl. dr. 

Action of Broom. 

External. — None. 

Internal. — Nervous System. — Its alkaloid sparteine if given 
in poisonous doses causes, in the lower animals, tremblings, 
incoordination, increase of reflexes, clonic and tonic convul- 
sions, followed by enfeeblement of all the functions, paralysis, 
and death from asphyxia. 

Respiration. — It paralyzes the respiratory centres, causes 
embarrassment of the respiration, and paralyzes the motor 
centres of the spinal cord, but has a very feeble influence upon 
the muscles; lessening, though not destroying, their excitability. 

Circulation. — Under the influence of this alkaloid, it is stated, 
there is a very great increase in the size and height of the 



BUCHU. 523 

cardiac wave. If the dose has been a small one, the pulse is 
at first accelerated; after large doses there is a slowing, fol- 
lowed by enfeeblement of the heart. The arterial pressure is 
not materially changed unless the dose is toxic, when it falls. 
Small doses weaken, and large ones paralyze the pneumogas- 
tric; upon the vaso-motor system it appears to have no influ- 
ence, unless in very large toxic doses, when it may perhaps act 
as a paralyzant. 

Kidneys. — Broom is of value as a diuretic. Scoparin prob- 
ably represents the diuretic principles of the plant. 

Therapeutics of Broom. 

Broom is a very useful diuretic, which is generally prescribed 
in association with other diuretics in cases of dropsy from heart 
disease or chronic nephritis. In acute nephritis, or where pul- 
monary congestion or inflammation is present, it is contra- 
indicated. According to some authorities, sparteine sulphate is 
of very great value in producing regularity in cases of irregular 
cardiac action. It accelerates the beats when a weak, atonic 
state is present, and has the great advantage of acting quickly. 
On the whole, it is probably inferior to digitalis in power, but 
it is not cumulative, and is a useful remedy in uncompensated 
cardiac, especially mitral, disease. In the treatment of the 
opium habit it has been employed to stimulate the heart's action 
at periods of depression. 

BUCHU. 

BUCHU.— Buchu (Bucco). Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Buchu. — Fluidextract of Buchu. Dose, 2 
c.c.; 30 ni. 

Action of Buchu. 

In moderate doses buchu causes in the stomach a feeling of 

warmth, which is often diffused gradually over the body. In 

large doses it gives rise to nausea, vomiting, purging and 

strangury, with a burning sensation in the epigastric region. 



524 PHARMACOLOGY AND THERAPEUTICS. 

Buchu stimulates the appetite and digestion, and slightly in- 
creases the pulse-rate. Its volatile oil, which is diffused into 
the blood, is excreted by the kidneys, the bronchial mucous 
membrane, which it stimulates, and probably also by the skin, 
as it induces mild diaphoresis. The excretion is chiefly by the 
urine, which it renders slightly antiseptic, but, although it is 
generally regarded as a diuretic, it does not appear to appre- 
ciably increase the renal activity. Under its influence the urine 
becomes darker in' color, assumes an aromatic odor, and depos- 
its a brownish sediment. After its elimination by the kidneys 
it acts as a disinfectant to the urinary tract. The free use of 
buchu, if continued for a considerable period, is said to be in- 
jurious to the kidney. 

Therapeutics of Buchu. 
It has been used in atonic dyspepsia, certain cutaneous affec- 
tions, dropsy, and chronic rheumatism. It is difficult to see how 
it could have any effect in the last of these conditions, and in 
dropsy also it probably does no good when given by itself. The 
infusion (B. P., 1 to 20, dose 30 to 60 c.c. ; 1 to 2 fl. oz.) con- 
tains very little of the volatile oil, but is an excellent vehicle 
for saline diuretics. The chief therapeutic use of buchu is in 
chronic affections of the mucous membrane of the genito- 
urinary tract, and it is a valuable remedy in pyelitis, lithiasis, 
cystitis, urethritis, and prostatitis. It is also occasionally pre- 
scribed as an expectorant in bronchitis. It is well to note that 
the fluidextract, on account of the oil in its composition, is not 
readily miscible with water. 

UVA URSI. 
UVA URSI.— Uva Ursi (Bearberry). Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Uvae Ursi. — Fluidextract of Uva Ursi. Dose, 
2 c.c; 30 Tn_. 

Unofficial Preparations. 
Extractum Uvae Ursi (U. S. P., 1890). — Extract of Uva Ursi. 
Dose, 0.25 to 1.00 gm.; 5 to 15 gr. 
Arbutinum. — Arbutin. Dose, .20 to .30 gm.; 3 to 5 gr. 



UVA URSI. 525 

Action of Uva Ursi. 
Uva ursi is a tonic, astringent and diuretic, and is also re- 
puted to have some oxytocic action. In medicinal doses it 
promotes the appetite and has a somewhat constipating effect 
upon the bowels. Large doses ordinarily occasion vomiting 
and purging, but it is stated that these effects may be prevented 
by filtering the watery preparations through animal charcoal, 
or by administering the glucosides instead of the cruder prep- 
arations. Arbutin is decomposed by the action of acids or of 
emulsin into glucose and hydroquinone or methylhydroquinone, 
and in the body a part of the arbutin appears to undergo this 
decomposition. The larger portion of it, however, is found to 
be eliminated by the kidneys unchanged, and it has been sug- 
gested that the small amount of hydroquinone and methylhydro- 
quinone which appears in the urine may perhaps be formed 
from arbutin by the bacteria of the intestine, and not by the 
activity of the tissues. The diuretic effect of uva ursi seems 
to be unquestionably due to the direct action of the drug upon 
the renal epithelium. It also has a decidedly anti-putrefactive 
effect upon the urine, which was formerly attributed to the 
formation of hydroquinone, but which is now believed to be 
due to the arbutin itself; which, in addition to exerting a mod- 
erate stimulant action on the kidney cells, appears to be some- 
what antiseptic. Uva ursi is therefore a mild disinfectant to 
the urinary tract. Under its influence the urine often becomes 
dark in color, the discoloration becoming more marked when 
it is allowed to stand and undergo putrefaction, and this is due 
to the hydroquinone, which becomes further oxidized and forms 
brownish-green pigments similar to those observed after phenol 
and other agents of its class. 

Therapeutics of Uva Ursi. 
Like buchu, it is used in pyelitis, cystitis, urethritis, etc. It 
often serves to relieve incontinence of urine, dysuria and stran- 
gury, and the fluidextract is an excellent remedy for the ardor 
urinae of acute gonorrhoea. Arbutin has been successfully em- 



526 PHARMACOLOGY AND THERAPEUTICS. 

ployed in gonorrhoea and also as a diuretic in cardiac dropsy. 
Uva ursi is said to have sometimes proved serviceable in uter- 
ine haemorrhages. 

SABAL. 
SABAL.— Sabal. Dose, 1 gm.; 15 gr. 

Unofficial Preparation. 
Fluidextractum Sabal. — Fluidextract of Sabal. Dose, 2 c.c; 
30 Hi. 

Action of Sabal. 
It is a nutrient, tonic and diuretic, and also has expectorant 
and sedative properties. Under its use the digestion is im- 
proved and the strength and weight increased, and it likewise 
tends to induce sleep. Its volatile oil is excreted mainly by the 
mucous membranes, and on these its principal effects are 
exerted. 

Therapeutics of Sabal. 
In general, all catarrhal conditions are improved by sabal, 
especially when it is combined with oil of santal. It has been 
employed for irritated states of the mucous membrane of the 
nose, pharynx, larynx and bronchial tubes. It relieves cough 
of various kinds, and is of some service in chronic bronchitis, 
laryngeal phthisis, and cardiac asthma. It is also given in cys- 
titis and to relieve the vesical distress of prostatic hypertrophy, 
and is thought to be more or less effective in functional im- 
potence. 

JUNIPER. 
OLEUM JUNIPER!.— Oil of Juniper. Dose, 0.2 c.c; 3 111 • 

Preparations. 

1. Spiritus Juniperi. — Spirit of Juniper. Dose, 2 c.c; 30 ni . 

2. Spiritus Juniperi Compositus. — Compound Spirit of 
Juniper. Dose, 8 c.c; 2 fl. dr. 

Action of Oil of Juniper. 
Oil of juniper is a stomachic tonic, antiseptic, diaphoretic, 
diuretic and aphrodisiac. Its action is practically the same as 



PAREIRA. 5 27 

that of oil of turpentine, but it is less apt to interfere with the 
digestion or to cause hematuria and albuminuria. It is, how- 
ever, a powerful renal stimulant and in large doses irritant; so 
that from sufficient amounts there may result strangury, pria- 
pism, hematuria, suppression of urine, and ursemic convul- 
sions. It imparts a violaceous odor to the urine, and will 
produce diuresis when inhaled in an atomized solution. Be- 
cause of its antiseptic properties it is employed for the preser- 
vation of cat-gut. 

Therapeutics of Oil of Juniper. 
It is a very efficient diuretic, and is largely used, combined 
with other less irritant diuretics, in the treatment of dropsies 
resulting from cirrhosis of the liver, organic heart disease, and 
chronic Bright's disease. As it is a constituent of gin, this, or 
the compound spirit of juniper, may be given to patients suffer- 
ing from such affections who require alcoholic stimulus. Oil 
of juniper may also be used in chronic pyelitis, cystitis, pros- 
tatorrhcea, gleet, etc., but it should never be prescribed when 
acute nephritis is present. Occasionally it is employed as a 
carminative and stomachic. 

PAREIRA. 
PAREIRA. — Pareira (Pareira Brava). Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Pareirae. — Fluidextract of Pareira. Dose, 2 
c.c; 30 TH,. 

Action of Pareira. 
With the exception of its diuretic action, in which it closely 
resembles buchu, pareira is not known to have any physiological 
effects. 

Therapeutics of Pareira. 
Like buchu, it is employed in chronic pyelitis, vesical catarrh, 
gleet, and other chronic inflammatory affections of the genito- 
urinary tract. It was formerly renowned as a lithontriptic. 



528 PHARMACOLOGY AND THERAPEUTICS. 

PICHI. 

FABIANA.— Pichi (not official). Dose, 2 gm.; 30 gr. 

Unofficial Preparation. 
Fluidextractum Fabianae. — Fluidextract of Fabiana. Dose, 
.30 to 2.50 c.c; 5 to 40 n\. 

Action of Pichi. 
Pichi is a diuretic with properties similar to those of buchu 
and uva ursi. 

Therapeutics of Pichi. 
It is of great value in inflammation of the bladder and 
catarrh of the urinary tract. It should not be used in organic 
disease. It is best prescribed in combination with an alkali, 
as sodium carbonate. 

THEOBROMINE. 

THEOBROMINE SODIO-SALICYLAS. — Theobromine Sodio- 

salicylate (not official). Dose, 1.0 to 20 gm.; 15 to 30 gr. 

Action of Theobromine Sodio-Salicylate. 
This is a pure diuretic, acting upon the renal epithelium, 
without action upon the heart, and it is believed that it does not 
irritate the kidneys. 

Therapeutics of Theobromine Sodio-Salicylate. 
The daily dose is from 4 to 8 gm. (1 to 2 dr.), best admin- 
istered in solution with aromatic water. It has been given 
with benefit in cases of severe cardiac or hepatic dropsy. It 
does not ordinarily cause depression, but in occasional instances 
is said to have had an untoward action. This may, however, 
have been due to impurities. 

APOCYNUM. 

APOCYNUM.— Apocynum. (Canadian Hemp.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Apocyni, — Fluidextract of Apocynum. Dose, 
1 c,c.; 15 TT\, 



STRONTIUM. 529 

Unofficial Preparation. 
Infusum Apocyni. — Infusion of Apocynum. Dose, 30 to 
60 c.c; 1 to 2 fl. oz. 

Action of Apocynum. 

When used as an infusion (1 to 16), Canadian hemp is not 
only diuretic, but has an action resembling that of strophanthus 
and similar drugs. In large doses it is also a hydragogue 
cathartic. 

Therapeutics of Apocynum. 

This is a more valuable medicinal agent than its limited use 
would indicate. It frequently produces copious diuresis after 
other, and better known, drugs have failed, and the infusion, 
especially, has been found beneficial in dropsy. 

CORN-SILK. 

ZEA.— Zea. (Corn-silk.) 

Unofficial Preparations. 
Fluidextractum Zeae. — Fluidextract of Zea. Dose, 2 to 8 
c.c; y 2 to 2 fl. dr. 
Infusum Zeae. — Infusion of Zea. Dose, freely. 

Action of Corn-Silk. 

Corn-silk is a mild but fairly certain diuretic when given in 
full doses. It increases the secretion of urine in consequence 
of the effect of its resinous acid in stimulating the renal epi- 
thelium. 

Therapeutics of Corn-Silk. 

It is useful in acute and chronic cystitis, in the bladder irri- 
tation of uric acid, and for phosphatic gravel. It is possibly, 
as well, a cardiac stimulant in the dropsy of heart disease. 
It is best administered in the form of an infusion, in boiling 
water (1 to 8), taken almost ad libitum. 

STRONTIUM. 
1. STRONTII LACTAS (U. S. P., 1890; no longer official).— 
Strontium Lactate. Dose, 1 to 8 gm.; y 4 to 2 dr. 

35 



530 PHARMACOLOGY AND THERAPEUTICS. 

2. STRONTII BROMIDUM. See Bromine. 

3. STRONTII IODIDUM. See Iodine. 

4. STRONTII SALICYLAS. See Salicylic Acid. 

Action of Strontium Lactate. 
The strontium salts have been demonstrated to be harmless 
to animals and men, and to have a diuretic action. If given 
for some time and in large quantities they impair gastric diges- 
tion and subsequently the general nutrition. The lactate re- 
duces the amount of albumin in albuminuria, and it is claimed 
to have a sedative effect on the heart in diseases of the valves 
and of the muscular tissue. It also checks fermentation and 
putrefaction in the small intestine. 

Therapeutics of Strontium Lactate. 
The strontium salts improve the appetite and facilitate diges- 
tion in gastric affections, and are also used in chronic intestinal 
catarrh. The lactate is useful in albuminuria, due to renal 
atony, on account of its diuretic properties, but not in uraemia, 
nor in interstitial nephritis, nor in the high fever of acute 
parenchymatous nephritis. In chronic renal disease due to 
scrofula, rheumatism or gout it is of service. It is also thought 
to have a decidedly beneficial action in diabetes of hepatic 
origin, and in cirrhosis of the liver. 

PIPERAZINE. 

Unofficial Preparations. 
1. Piperazinum. — Piperazine. (Piperazidine. Diethlenedia- 
mine. Dispermine.) Dose, .50 to 1 gm.; 8 to 15 gr. 

2. Lysidinum. — Lysidine. Dose, 2 to 10 c.c; y 2 to 2 x / 2 
fl. dr., daily. 

3. Lycetol.— Lycetol. Dose, .90 to 1.80 gm.; 15 to 30 gr. 

Action of Piperazine. 
Piperazine is believed to increase slightly the amount of urea 
in the urine, while the uric acid coefficient is diminished. The 
testimony as to its diuretic action is conflicting, but the weight 



CANTHARIDES. 53 1 

of clinical evidence is in favor of its being a reliable diuretic. 
In ordinary doses it does not appear to have arty influence upon 
the nervous, circulatory or respiratory systems; nor does it 
irritate the gastro-intestinal or the genito-urinary tract. 

Therapeutics of Piperazine. 

There is much clinical testimony as to the value of this drug 
in gout, goutiness (uricacidaemia) and rheumatism. It is here 
given in water containing carbon dioxide. It is so highly 
hygroscopic that it cannot be administered as pill or powder. 

Lysidine, which is a base obtained by the action of sodium 
acetate upon ethylene-diamine hydrochlorate, is reputed to 
have an even more pronounced effect in uricacidaemia than 
piperazine. It is said to have been given in cases of chronic 
gout with good results, especially as regards lessening of the 
joint-stiffness and reduction in the tophi around the joints. 
The dose is 2 to 10 c.c. (J-4-2^ fl. dr.) of the 50 per cent, 
alkaline solution, administered in a glassful of carbonated 
water. 

Lycetol, or dimethyl-piperazine tartrate, has been introduced 
for the purpose of combining the action of piperazine with the 
alkalizing and diuretic effects of a tartrate. It may be given 
in carbonated water or in the form of a lemonade. 

CANTHARIDES. 
CANTHARIS. — Cantharides. (Spanish Flies. Blister Beetles.) 



Preparations. 

1. Ceratum Cantharidis. — Cantharides Cerate. 

2. Collodium Cantharidatum. — Cantharidal Collodion. 

3. Tinctura Cantharidis. — Tincture of Cantharides. Dose, 
0.3 c.c; 5 TTL- 

Unofficial Preparation. 
Potassii Cantharidinatum. — Potassium Cantharidinate. Dose, 
.0006 gm.; t ±q gr., hypodermatically. 



532 pharmacology and therapeutics. 

Action of Cantharides. 

External. — Cantharides is a powerful irritant, but the irri- 
tant action of this and other agents of its class still remains 
unexplained. It acts more slowly than most irritants, so that 
if a preparation of cantharides is applied to the skin, it will 
usually be two or three hours before any appreciable effect is 
produced. The first symptom from it is a tingling, burning 
pain in the part, which very shortly becomes reddened in con- 
sequence of the local vascular dilatation caused. In the course 
of three or four hours after the application numerous vesicles 
make their appearance, and these soon coalesce, forming one 
large blebs (varying in area according to the extent of the 
application), which is filled with clear serum. Although the 
local action is thus a violent one, it is also very superficial. 
Hence, as less of the irritant penetrates into the deeper tissues 
than in the case of the volatile oil of mustard, and the process 
is so much slower, the vesication is much less painful than 
that caused by mustard. If the blister be broken, however, and 
the irritant be allowed to come in contact with the unprotected 
dermis, severe inflammation with much pain, suppuration and 
even sloughing is liable to result. Cantharides is an energetic 
counter-irritant, as well as a rubefacient and vesicant, and this 
action is probably due to an alteration in the calibre of the 
blood-vessels and in the sensory nerves, or their terminations, 
reflexly induced by it in the deep-seated organs in the vicinity 
of the part to which it is applied. 

Cantharidin may be absorbed through the skin and in this 
way produce the constitutional effects of the drug. 

Internal. — G astro-intestinal Tract. — When taken in sufficient 
quantity by the mouth, cantharides produces the same irritant 
effect along the alimentary canal, and gastro-enteritis results. 
If cantharidin is swallowed in solution, blisters are formed in 
the mouth and throat, and deglutition is rendered difficult or 
impossible by the excruciating pain and the swelling in the 
oesophagus caused by it. There is also intense pain in the 
abdomen, and vomiting ensues, followed by purging, with all 



CANTHARIDES. 533 

the symptoms of shock and collapse. Both the matters vom- 
ited and the stools may contain blood. Ulceration of the 
stomach and other portions of the alimentary canal have been 
observed after death, not only when cantharides has been ad- 
ministered by the mouth, but also when the drug has been given 
by subcutaneous injection, and it is thought possible that under 
these circumstances it is excreted in part by the stomach, and 
that these lesions are produced in the act of excretion. 

Genito-urinary Tract. — Cantharidin is absorbed from the ali- 
mentary canal and also to a less extent from the skin, and will 
exert its irritant action elsewhere, especially upon the organs 
of excretion. The effect upon the kidneys is seen in diuresis, 
and when a larger amount is absorbed, in nephritis, albuminu- 
ria, hematuria, glycosuria, and sometimes in total suppression 
of urine. The other parts of the urinary tract, the bladder and 
urethra, also show the action of the irritant, and strangury, 
with a constant desire for micturition, priapism, etc., is reflexly 
induced. The vesical tenesmus is extreme, and the patient suf- 
fers from severe pain in the loins. The local irritation is apt 
to occasion erotic excitement, with seminal emissions in the 
male, and there may also be swelling and inflammation of the 
external genitals. Sufficient of the active principle may be 
absorbed from a cantharides blister to cause marked renal irri- 
tation and strangury. The drug is chiefly excreted by the kid- 
ney, and the nephritis is the main factor in death from can- 
tharidal poisoning. 

Nervous System. — While cantharidin, thus absorbed, has no 
important action upon the internal organs other than those by 
which it is eliminated, when injected into the circulation of 
animals this agent is stated to affect the central nervous system 
much in the same way as phenol, producing short stimulation, 
excitement and increased reflexes, followed by paralytic symp- 
toms, coma, etc. It is found, however, that this central action 
is not often observed, as it is mostly obscured by the gastro- 
enteritis or nephritis. 



534 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Cantharides. 
External. — Cantharides is of all drugs the most commonly 
used as a vesicant and counter-irritant. Blisters may be spread 
with cerate of cantharides, or preferably with the cerate of the 
extract of cantharides (U. S. P., 1880). The raised cuticle 
should not be removed, but simply punctured to allow the 
escape of the serum, and the surface should then be dressed 
with some bland fat. A very convenient method of blistering 
is to paint the desired area with one or two coats of can- 
tharidal collodion, and then lay over it a piece of waxed paper. 
In using a blistering plaster sodium bicarbonate or a little mor- 
phine with powdered camphor may be sprinkled over its sur- 
face before it is applied, for the purpose of lessening the danger 
of strangury, and with the same end in view the preliminary use 
of an alkaline diuretic has been suggested. The tendency to 
strangury is also diminished by the free use of diluent drinks. 
Blisters are employed to relieve pain, reduce inflammation, and 
promote the removal of inflammatory products by absorption. 
They are thus of service in a great variety of conditions, al- 
though not in such general use as formerly, when heroic meth- 
ods of treatment were more in vogue. Only a few of the spe- 
cial uses of blisters need be referred to here. They are ap- 
plied over the chest in pleuritic effusions (a succession of small 
blisters being most efficacious), behind the ear in aural inflam- 
mations, on the perineum in obstinate gleet, around the affected 
joints in acute rheumatism, at the nape of the neck in severe 
headaches, and over the epigastrium for persistent pain in the 
stomach, vomiting, etc. They are of great value in neuralgia, 
especially if applied close to the emergence of the nerve from 
the spinal column, and also in sciatica and neuritis and in sub- 
acute joint affections. It has been shown by careful researches 
that a distinct relation exists between irritation of an internal 
organ and that part of the skin which is supplied by the same 
segment of the spinal cord or brain. While these superficial 
points are connected with the diseased organ only by means of 
nerve-fibres, it appears that a nervous impulse from these 



CANTHARIDES. 535 

organs does not pass in an indeterminate manner through the 
central nervous system, but has a distinct tendency to affect 
the superficial areas which are supplied with sensory nerves 
from the same segment of the cord. It is therefore argued 
that an affection of these superficial areas may affect the cor- 
responding internal organ more than the rest of the body, and 
that this satisfactorily explains the benefits derived from 
counter-irritants. In confirmation of this, attention is called to 
the fact that several of the points which were observed to be 
affected by internal disease are precisely those points at which 
experience has shown irritation to be of most service. Thus, 
the application of a blister to the epigastrium has long been 
recognized as a means of relieving stomach disorders, while the 
old treatment of iritis by means of a blister on the temple may 
be justified by the fact that in the researches mentioned an 
area of tenderness in this region was found to accompany the 
eye-disease. An aura proceeding from an extremity may some- 
times be intercepted, and epileptic seizures averted, by encirc- 
ling the limb with a strip of blistering-plaster. The moral 
impression produced by the use of vesication is not infrequently 
very beneficial. Hysterical paralysis is most successfully 
treated by encircling the affected extremity with narrow blis- 
ters, and hysterical aphonia may sometimes be quickly cured 
by a blister over the larynx. If in any case an especially pro- 
nounced counter-irritant effect is desired, the blister, after hav- 
ing been punctured, may be irritated by the application of an 
irritating ointment. Unguentum Sabinae (savin, 8; yellow 
wax, 3; benzoated lard, 16) was formerly much used for this 
purpose. In blistering with cantharidal preparations the plas- 
ter should be removed as soon as the blebs has formed, on 
account of the danger of the absorption of cantharidin. When 
strangury is produced, relief may be afforded by an enema of 
laudanum or by a small hypodermatic injection of morphine. 
Among the conditions contra-indicating the use of blisters in 
general may be mentioned the acute stage of an inflammation, 
scurvy and purpura, pregnancy, infancy and debility. They 



536 PHARMACOLOGY AND THERAPEUTICS. 

should never be applied to a part on which a patient lies, on 
account of the risk of the formation of bed-sores, or to para- 
lyzed limbs. Cantharidal blistering is contra-indicated in renal 
disease or inflammation of the urinary passages, and here vesica- 
tion by ammonia water or chloroform (evaporation being pre- 
vented) may be substituted for it. These are rather more rapid 
in action, but much more painful than cantharides. By some 
it is advised that blisters should not be opened at all, but should 
be covered with antiseptic wool, by which means ulceration 
and inflammatory complications may be avoided. It is held 
also that the removal of the serum is practically equivalent to 
a blood-letting of the same amount, and that this is very rarely 
desirable. The cuticle raised by a blister may be used for skin- 
grafting. 

Cantharides is one of the most common and useful remedies 
employed in the treatment of loss of hair. Good results may 
often be obtained from its use if the alopecia has not progressed 
too far, but it is hardly likely to prove of service if the treat- 
ment is begun late. It is usually applied in the form of tinc- 
ture, largely diluted with alcohol, or as the active constituent 
of a pomade. Some such preparation as the following may 
also be employed to stimulate the growth of hair: Vinegar of 
cantharides (B. P., cantharides, 1; glacial acetic acid, 5; 
water), 1; glycerin, 1; spirit of rosemary, 1; water, 10. In 
alopecia circumscripta cantharidal collodion, painted over the 
bald patches every week or ten days, is occasionally successful. 

Internal. — On account of its irritating properties cantharides 
is used internally to only a limited extent. It is given in the 
form of the tincture, in small doses, principally as a stimulant 
to the urinary organs, and among the conditions in which it 
has been commended are hematuria, incontinence of urine, 
chronic pyelitis, chronic cystitis, irritability of the bladder, 
gleet, prostatorrhcea, and spermatorrhoea due to deficient tone 
of the seminal vesicles. It is naturally contra-indicated when 
any active inflammation is present. Cantharides has some 
popular reputation as an emmenagogue, but if it has any influ- 



CANTHARIDES. 537 

ence at all upon the menstrual function, this is quite insignifi- 
cant, and due, no doubt, only to its irritant effect upon the 
urinary organs and passages. It is one of the drugs most 
relied upon in the treatment of impotence, in which condition 
it may prove of service through reflex irritation from the 
urethral mucous membrane. Its administration is attended 
with considerable danger, however, since efficient doses are apt 
to induce nephritis. Several cases of poisoning have been re- 
ported from its use as an aphrodisiac, though it is stated that its 
aphrodisiac effect is usually more manifest under ordinary or 
even small medicinal doses than from immoderate amounts. 
Sometimes, but not often, it relieves chordee. Small doses are 
sometimes useful in the late stage of acute desquamative nephri- 
tis. It has been recommended for diabetes insipidus. Can- 
tharidin, in the form of potassium cantharidinate, administered, 
has been used as a remedy for pulmonary tuberculosis, and for 
lupus. Notwithstanding that cures of both of these diseases 
have been claimed, the value of the drug in such conditions is 
by no means established. 

TOXICOLOGY. 

Symptoms. — The effects of toxic doses of cantharides have already- 
been described. In cases where lethal amounts have been taken, there 
usually result dyspnoea, great frequency of the pulse, and finally col- 
lapse and coma, death being sometimes preceded by convulsions. These 
fatal effects would appear to be dependent upon suppression of the 
urinary functions in consequence of the violent nephritis caused by 
the drug. It is one of the substances employed for the purpose of 
producing abortion with criminal intent, and it is in cases of this 
kind that symptoms of poisoning are most likely to be observed. 

Post-Mortem. — There are found swelling and intense hyperemia of 
the gastro-intestinal mucous membrane, with ecchymoses and often 
ulceration, and the appearances of acute inflammatory action also in 
the kidneys, bladder and whole genito-urinary tract. 

Treatment. — There is no chemical or physiological antidote to 
Cantharides. The stomach should be emptied by emetics (see p. 175), 
or washed out by the stomach-pump. Mucilaginous and demulcent 
liquids should be freely given. Opium is indicated to relieve the pain 
and gastro-enteritis. 



538 PHARMACOLOGY AND THERAPEUTICS. 

TRITIOUM. 
TRITICUM.— Triticum. (Couch-grass.) Dose, 8 gin.; 120 gr. 

Preparation. 
Fluidextractum Tritici. — Fluidextract of Triticum. Dose, 8 
c.c; 2 fl. dr. 

Unofficial Preparation. 
Infusum Tritici. — Infusion of Triticum. Dose, freely. 

Action of Triticum. 
Triticum is emollient and demulcent, and has some nutrient 
qualities. It has been regarded as a diuretic also, but the in- 
crease in the amount of urine noted under its use appears to 
be due simply to the water given with it. 

Therapeutics of Triticum. 
For its soothing and supposed diuretic properties it has been 
used in dysuria, irritability of the bladder, chronic cystitis, irri- 
table prostate, gleet, and other affections of the genito-urinary 
tract. The infusion is a popular fever-drink in Europe. 



B. Drugs Preventing the Urine from Decomposing. 

UROTROPIN. 

HEXAMETHYLENAMINA. — Hexamethylenamine. Hexamethyl- 
ene Tetramine. (Urotropin.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Action of Urotropin. 
Large doses in man, e. g. (io gm. ; 150 gr.), are well borne; 
intravenous injections in rabbits and dogs do not increase, but, 
rather, slightly lower blood-pressure. Very large doses cause 
albuminuria in rabbits and hematuria in dogs. Of most im- 
portance is the inhibitory action of this remedy upon micro- 
organisms when it is split up into formaldehyde and ammonia, 
the former being the active agent. This takes place for the 



BENZOIN. 539 

most part, after ingestion, in the urine, which is not only of the 
proper temperature for the purpose, but also contains uric acid 
and acid salts which are efficient. Further, as has been shown, 
it will dissolve uric acid at the temperature of the body. Lastly, 
it may or may not produce diuresis. 

Therapeutics of Urotropin. 

This remedy is of especial value in diseases of the urinary 
passages. In ammoniacal fermentation of the urine, which is 
extremely frequent in the cystitis of prostatic hypertrophy, the 
maximum dose given for two or three successive days is effi- 
cient in clearing that excretion. Inasmuch as the growth of 
the micro-organisms is inhibited, the remedy should be con- 
tinued in sufficient amount to maintain this result. In gonor- 
rhceal posterior urethritis, cystitis and pyelitis the results are 
equally favorable. It may be employed as a prophylactic meas- 
ure before operations upon the genito-urinary tract. For the 
uric acid diathesis it has been used with good results by most, 
with failure by a very few, physicians. Since it is not always 
diuretic, other measures should be employed to increase kidney 
action. As a so-called lithontriptic some success has been 
claimed. For phosphaturia excellent results are reported. In- 
asmuch as the specific bacillus of the disease is found in a very 
considerable percentage of urines from patients suffering from 
typhoid fever, and failure to disinfect this excretion is a source 
of danger, urotropin should be administered not only for this 
purpose but also in order to avoid the cystitis which sometimes 
supervenes in the course of this disease. 

BENZOIN. 

BENZOINUM.— Benzoin. (Gum Benjamin.) Dose, 1 gm.; 15 gr. 

Preparations. 

1. Adeps Benzoinatus. — Benzoinated Lard. 

2. Tinctura Benzoini. — Tincture of Benzoin. Dose, 1 c.c; 
15 TT\. 



540 PHARMACOLOGY AND THERAPEUTICS. 

3. Tinctura Benzoini Composita. — Compound Tincture of 
Benzoin. (Friar's Balsam.) Dose, 2 C.C.; 30 TIT.. 
ACIDUM BENZOICUM.— Benzoic Acid. Dose, 0.500 gm. (500 
milligm.) ; 7y 2 gr. 

Preparations. 
Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 1 
fl. dr. 

Ammonii Benzoas. — Ammonium Benzoate. Dose, 1 gm.; 
15 gr. 
Lithii Benzoas. — Lithium Benzoate. Dose, 1 gm.; 15 gr. 
Sodii Benzoas. — Sodium Benzoate. Dose, 1 gm.; 15 gr. 

Unofficial Preparations. 
Bismuthi Benzoas. — Bismuth Benzoate. Dose, 1 gm-; 15 gr. 
Acidum Cinnamicum. — Cinnamic Acid. Dose, .30 to .60 
gm.; 5 to 10 gr. 

Action of Benzoic Acid. 

As benzoic acid, its salts, and benzoin all have practically the 
same action, that of benzoic acid only will be here described. 

External. — Like salicylic acid, it is irritant to mucous mem- 
branes, and its vapors when inhaled are capable of exciting a 
catarrhal condition of the bronchial membrane. When ap- 
plied in a concentrated form it is also irritant to the skin. In 
antiseptic power it appears to be equalj if not superior, to sali- 
cylic acid, preventing the growth of many forms of bacteria in 
a solution of I in iooo. 

Internal. — In the body its action is in many respects very 
similar to that of salicylic acid, and, like the latter, it may be 
taken in comparatively large quantities without the production 
of toxic symptoms. In very large doses it sometimes causes 
nausea and vomiting, and in occasional instances the matters 
vomited may be tinged with blood. It produces a moderate 
acceleration of the pulse, and has some effect in increasing and 
disinfecting the bronchial secretion. It is therefore regarded 
as an expectorant, and it is thought probable that either the 
acid or one of its derivatives is excreted by the bronchial mu- 
cous membrane. It is said also to be excreted by the skin, 



BENZOIN. 541 

and thus stimulate its functional activity, though this has been 
denied by some. It differs from salicylic acid in being less 
stimulant to the central nervous system, and in man a certain 
sedative effect has been observed under it. In dogs it may 
give rise to tremors and convulsions, and the following phe- 
nomena have also been observed: Ataxia and paresis, followed 
successively by complete paralysis of the anterior and posterior 
extremities and trunk; fall of temperature; death from as- 
phyxia. The pulse and respiration are first accelerated and 
then slowed, from a direct action on the heart and on the res- 
piratory centre. As the gastric mucous membrane has been 
found after death to be eroded and ecchymosed, even when the 
acid has been injected subcutaneously or intravenously, it is 
believed that benzoic acid has a specific action on this mem- 
brane quite apart from its irritant effects when applied locally. 
In the dog, as well as in man, vomiting is produced when the 
acid is given by the mouth in sufficient quantity. While traces 
of benzoic acid have been found in the saliva of dogs after the 
administration of the drug, it is thought that it is not excreted 
by the salivary glands in man. It no doubt lessens the putre- 
faction in the intestinal canal, as some diminution in the double 
sulphates and the indican of the urine has been observed after 
its administration by the mouth. Benzoic acid and the ben- 
zoates, particularly sodium benzoate, appear to have the effect 
of somewhat stimulating the functional activity of the liver. 

An important feature of the action of benzoic acid is that it 
is in great part excreted in the urine as hippuric acid, which is 
formed in the body from a combination with glycocoll. Hip- 
puric acid is benzoyl-glycocoll (or glycosine), so that a syn- 
thetic process takes place, benzoic acid combining with glyco- 
coll, and hippuric acid and water being the result — 

C 6 H 5 • COOH + H 2 N • CH 2 ■ COOH = 

C 6 H 5 • CO ■ HN • CH 2 ■ COOH + H 2 0. 

It has not as yet been determined from what source the nitro- 
gen required for this is derived. Some of the benzoic acid 



542 PHARMACOLOGY AND THERAPEUTICS. 

escapes in the urine, and the proportion of hippuric acid formed 
appears to depend more or less upon the condition of the kid- 
neys (in which the synthesis takes place) and of the general 
health, as well as upon the amount of benzoic acid ingested. 

If hippuric acid is given by the mouth, it is stated that ben- 
zoic acid is found in the blood, but that hippuric acid reappears 
in the urine. When benzoic acid has been administered to the 
mother shortly before delivery, hippuric acid has been observed 
in the urine of the new-born infant. It is generally believed 
that the hippuric acid formed from benzoic acid in the system 
increases the acidity of the urine and renders alkaline uric 
acid, while it also tends to disinfect and stimulate the genito- 
urinary tract. Most clinicians agree that the acidity of the 
urine is increased after benzoic acid, and it is thought probable 
that the disappearance of uric acid crystals from the urine 
under its influence is due to the conversion of insoluble uric 
acid into soluble hippuric acid. It has been asserted by some, 
however, as the result of experiment, that sodium benzoate 
does not increase the acidity of the urine, and that the mistake 
of clinicians has arisen from the fact that in cystitis the urine 
has its acidity increased by the drug for the reason that the 
ammoniacal fermentation is checked by the benzoic acid. Dur- 
ing its excretion by the kidney benzoic acid slightly stimulates 
the renal cells, and thus has a mild diuretic effect. After large 
doses there has sometimes been found in the urine a reducing 
body, which is presumed to be glycuronic acid. By some it is 
believed that the reducing property of the urine is always the 
result of intoxication, so that unless symptoms of poisoning 
are present, no such reducing action will be observed. Phthalic 
acid, and possibly succinic acid, may also occasionally appear 
in the urine after the administration of benzoic acid. Benzoic 
acid is found to increase to a considerable extent the nitrogen 
eliminated in the urine, and it would therefore seem, like sali- 
cylic acid, to augment the decomposition of the proteids in the 
body. 



BENZOIN. 543 

The action of benzoic acid on the body-temperature is prob- 
ably similar to that of salicylic acid. 

One of the rarer results of the administration of the drug 
is urticaria or an erythematous condition of the skin. 

Therapeutics of Benzoic Acid. 
External. — On account of its marked antiseptic qualities, as 
well as its stimulating effect, the compound tincture of benzoin 
is quite largely used as a surgical dressing. It is applied on 
lint to wounds and ulcers or other sores, and when injected 
into old sinuses it disinfects the tract and promotes healing. 
It makes a good application for spongy gums, and is also used 
to paint over abrasions and excoriations, as in the case of 
tender nipples. Its use in the same way is recommended in 
the treatment of chilblains, after the part has been washed with 
a 5 per cent, solution of carbolic acid. It sometimes relieves 
the itching of urticaria or eczema, and, mixed with an equal 
quantity of glycerin, is serviceable for chapped lips and hands, 
chapped and fissured nipples, and frost-bite. A solution of 
tincture of benzoin in cologne-water is also often successful in 
urticaria, and a lotion made with the tincture, and containing 
mercuric chloride, may be applied for the removal of freckles 
or moth-spots and in pityriasis versicolor and chronic urticaria. 
In catarrhal affections of the pharynx and larynx the compound 
tincture, more or less diluted, makes an efficient application, 
and the hoarseness of singers and public speakers, the result 
of undue strain upon the vocal cords, is frequently relieved by 
this remedy. Bismuth benzoate (not official), which contains 
about 65 per cent, of bismuth, is an efficient dressing for chronic 
or sloughing ulcers and for venereal lesions of various kinds, 
and is usually dusted on the parts after they have been thor- 
oughly bathed with a weak solution of mercuric chloride. Ben- 
zoated lard is a favorite basis for ointments the active ingre- 
dient of which it is desired to have absorbed, as the benzoin 
prevents the decomposition of the lard when melted on the 
skin. Where the benzoin causes irritation, as it may near the 



544 PHARMACOLOGY AND THERAPEUTICS. 

eye, a non-irritant basis which keeps indefinitely may be made 
by adding 3 parts of oil of cloves or 2 of oil of gaultheria to 
480 parts of lard. 

Internal. — Urinary Organs. — The chief value of the benzoic 
compounds is no doubt in diseases accompanied by disordered 
conditions of the urine. Ammonium and sodium benzoate are 
preferable to benzoic acid itself on account of their much 
greater solubility, and they may with advantage be combined 
with some such sedative as hyoscyamus. Spirit of chloroform 
is sometimes employed to cover the taste. In pyelitis or cys- 
titis the alkalinity of an ammoniacal urine is promptly dimin- 
ished, the hippuric acid which is formed combines with ammo- 
nia to form ammonium hippurate, less triple phosphate results 
in consequence, and the condition is therefore ameliorated. As 
the acidity of the urine is increased by the salts, they may also 
be of more or less service in phosphaturia and in vesical cal- 
culus. During the presence of fever the transformation of ben- 
zoic acid into hippuric acid is much diminished, and in ad- 
vanced parenchymatous nephritis and amyloid disease of the 
kidney is entirely abolished, the benzoates being excreted as 
such. The latter fact goes to confirm the results obtained from 
experiments on dogs, showing that this change takes place only 
in the kidneys, and probably in the renal cells. In some ani- 
mals, however, notably the rabbit and the frog, the kidney is 
not the only place of synthesis. In certain cases of chronic 
Bright's disease the benzoates may be used with advantage. 
They are also sometimes of value in chronic gonorrhoea, in 
obstinate irritation of the urethra due to the condition of the 
urine, and in incontinence caused by an alkaline urinary reac- 
tion. 

Pulmonary Organs. — Benzoin and its derivatives, especially 
sodium benzoate, were at one time employed to a considerable 
extent in phthisis, but have now for the most part been aban- 
doned, as it has been found that they have no such effect on 
the tubercle bacillus as had been hoped, though they may some- 
times be of service when the sputum is fetid. In bronchitis 



copaiba. 545 

they are of more value, and in this affection, as well as in 
laryngitis, much benefit may often be derived from the inhala- 
tion of a mixture of compound tincture of benzoin (4 c.c. ; 1 
fl. dr.) and water (500 c.c; 1 pint), heated to a temperature 
of 6o° C. (140 F.). The simple or compound tincture is used 
also as an ingredient of expectorant mixtures, and is regarded 
as more especially beneficial when the mucus is tenacious and 
coughed up with difficulty. 

Other Uses. — Sodium benzoate has been lauded by some in 
the treatment of gout, but its value here is very questionable. 
The same is true as regards diphtheria, and it has quite fallen 
into disuse in this disease. It has been given as an antipyretic 
in pneumonia and in intermittent, typhoid, and other fevers, and 
on account of its antiseptic properties in erysipelas and puer- 
peral fever and other septic conditions, but without satisfactory 
results. In diseases of the alimentary canal the benzoates have 
proved of considerable value, though inferior to some other 
remedies. They are sometimes efficient in chronic diarrhoea 
and dysentery and the intestinal catarrh of children. As he- 
patic stimulants they are but little used, and even if the claims 
once made for them in this capacity were true, it is now ac- 
cepted that the functions of the liver can generally be much 
better modified indirectly than by direct action upon the organ. 
In acute rheumatism the benzoates appear to have somewhat 
the same effects as the salicylates, but are much less reliable. 

Cinnamic Acid is thought to resemble benzoic acid in its 
pharmacological characters. It is said to increase the leuco- 
cytes of the blood and the uric acid of the urine to a marked 
degree. 

COPAIBA. 

COPAIBA. — Copaiba. (Copaiva. Balsam of Copaiba.) Dose, 1 
c.c; 15 Til,. 

OLEUM COPAIBA.— Oil of Copaiba. Dose, 0.5 c.c; 8 TTL- 

Unofficial Preparations. 
Massa Copaibae. — Mass of Copaiba. Solidified Copaiba. (U. 
S. P., 1890.) Dose, 1.0 to 4.0 gin.; y 4 to 1 dr. 
36 



546 PHARMACOLOGY AND THERAPEUTICS. 

Resina Copaibae. — Resin of Copaiba. (U. S. P., 1890.) Dose, 
.30 to 1.00 gm.; 5 to 15 gr. 

Action of Copaiba. 

External. — Copaiba is slightly stimulating to the skin and 
mucous membranes, and is also antiseptic. 

Internal. — G astro-intestinal Tract. — Its taste is very unpleas- 
ant, and it often occasions disagreeable eructations, which taste 
of the drug. Its action is like that of other volatile oils, in 
ordinary doses causing a pleasant sense of warmth in the stom- 
ach, and in large amounts acting as a gastro-intestinal irritant, 
with the production of vomiting and purging. Like cubeb 
and sandalwood oil, however, it is less irritant to the stomach 
than many of the volatile oils, though its prolonged adminis- 
tration is apt to give rise to more or less gastric disturbance. 

Mucous Membrane. — After entering the circulation it is ex- 
creted to a considerable extent by the various mucous mem- 
branes, in the process stimulating their action and also having 
a disinfectant effect. It is thus a stimulating disinfectant to 
the bronchial mucous membrane and that of the genito-urinary 
tract, acting especially on the latter. It imparts to the mucous 
secretions and breath, as well as to the urine, a peculiar aro- 
matic odor. 

Skin. — It appears to be eliminated by the skin also, and in 
some instances it occasions cutaneous eruptions and annoying 
itching. The more common form of effervescence is a coarse 
rash, resembling measles, but sometimes there is urticaria, 
erythema or a bullous eruption. The cause of these eruptions 
is unknown. By some they have been attributed to the irritant 
effect of its excretion by the skin; by others to the gastric 
disturbance caused by the drug. 

Kidneys. — Copaiba is diuretic not only by virtue of its vola- 
tile oil, but also because of its resinous acid, which has an 
action both upon the bronchial mucous membrane and the kid- 
neys. This resin is excreted in the urine, where it may be 
precipitated by acids. The precipitate can be readily distin- 



copaiba. 547 

guished from albumin, as it is evenly distributed through the 
fluid and is dissolved by both heat and alcohol. While it might 
thus at first be mistaken for albumin, it also leads to confusion 
when Trommer's test is employed to detect glucose. As co- 
paiba exerts an antiseptic action in the urine, the bladder and 
urethra are bathed in an antiseptic, slightly irritant fluid, which 
not only tends to retard the growth of microbes, but also to 
promote the healing of lesions of the mucous membrane. In 
large doses it causes irritation in these parts, with a con- 
stant desire to micturate. The act of micturition is attended 
with difficulty and pain, and sometimes the pain is so severe 
as to lead to complete retention. Large quantities are also irri- 
tating to the kidneys, and from this cause may result a dimin- 
ished secretion, with blood and albumin in the urine. While 
copaiba is excreted partly by the lungs and mucous membranes 
and in the milk and other secretions, its main excretion takes 
place by the kidneys and in combination with glycuronic acid. 

Therapeutics of Copaiba. 

External. — Like other terebinthinates, copaiba serves to stim- 
ulate, as well as protect, parts to which it is applied. It is 
sometimes used as a dressing for chilblains, frost-bite, sore 
nipples, anal and other fissures, etc. A mixture of equal parts 
of copaiba and rosin cerate has been recommended as an effi- 
cient application for indolent ulcers. It has also been used, on 
account of its stimulating and antiseptic effects, in chronic 
skin diseases, such as psoriasis, lupus and leprosy, and as a 
topical application to the urethra or vagina in chronic gonor- 
rhoea. 

Internal. — Occasionally copaiba is employed as an expector- 
ant in bronchitis, especially where the secretion has become 
profuse and fetid. In chronic conditions it has the effect of 
diminishing, instead of increasing, secretion, and on this ac- 
count as well as its disinfectant properties, it may serve a use- 
ful purpose. The resin is an efficient diuretic for hepatic 
ascites and cardiac dropsy, but should not be used in Bright's 



548 PHARMACOLOGY AND THERAPEUTICS. 

disease on account of its irritant action upon the kidneys. It 
is, however, a very disagreeable remedy to take. The follow- 
ing mixture, for one dose, is probably as palatable as any that 
can be made: To I gm. (15 gr.) of resin of copaiba, rubbed up 
with 1 gm. (15 gr.) of tragacanth and 1.20 c.c. (20 Til) of 
alcohol, are added 4 c.c. (1 fl. dr.) of syrup of ginger in 30 
c.c. (1 fl. oz.) of water. It is found that after copaiba has 
been administered for some time it loses its effect to a consid- 
erable degree, so that the diuresis produced by it is less copious 
than at first. It was formerly given to a considerable extent 
in pyelitis, cystitis, vaginitis, and a variety of other affections, 
but at the present time its use is almost entirely restricted to 
the treatment of gonorrhoea and gleet. The reasons for this 
are its unpleasant taste, the offensive odor which the drug gives 
to the breath of those taking it, and its liability to cause dis- 
agreeable eructations, to derange the digestion, or to produce 
eruptions on the skin. In gonorrhoea it has proved so unde- 
niably efficacious, however, that in spite of the objectionable 
features attendant .upon its administration, it still holds its place 
as a standard remedy in this disease. It is regarded as safe 
to begin the use of copaiba in gonorrhoea as soon as the initial 
severity of the attack has subsided and the bowels have been 
freely opened. It is best administered in capsules, and may 
be combined with other agents if desired. 

CUBEB. 

CUBEBA.— Cubeb. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Cubebae. — Fluidextract of Cubeb. Dose, 1 
c.c; 15 TTt- 

2. Oleoresina Cubebae. — Oleoresin of Cubeb. Dose, 0.500 
gm. (500 milligm.); 7V 2 gr. 

3. Trochisci Cubebae.— Troches of Cubeb. 
OLEUM CUBEBA.— Oil of Cubeb. Dose, 0.5 c.c; 8 m.. 

Unofficial Preparation. 
Tinctura Cubebae (U. S. P., 1890).— Tincture of Cubeb. 
Dose, 2 to 12 c.c ; y 2 to 3 fl. dr. 



CUBEB. 549 

Action of Cubeb. 

External. — By reason of its volatile oil cubeb is irritant and 
rubefacient when applied by inunction. 

Internal. — Its action is much the same as that of copaiba, 
though it is somewhat less irritant. In small doses it is an 
aromatic stomachic and carminative, and assists digestion. 
Large doses cause marked gastric and sometimes intestinal 
irritation, with nausea, vomiting, abdominal pain, and perhaps 
purging, while the urine may contain albumin or blood, or 
both. It is absorbed, and, like other volatile oils, produces 
some cardiac stimulation and also stimulates the functions of 
the organs by which it is eliminated. It is excreted by the 
kidneys and lungs, and perhaps by the skin, and its chief action 
is on the mucous membrane of the genito-urinary tract. This 
is not only powerfully stimulated but also disinfected by it, as 
the urine containing the drug acts as a stimulant and antiseptic 
lotion. It sometimes gives rise to a cutaneous papular or 
erythematous eruption, but whether this is due to its excretion 
by the skin, as believed by some, or to the gastric disturbance 
is as yet undetermined. As cubeb induces considerable irrita- 
tion of the kidney, it is a diuretic. Containing, as it does, like 
copaiba, a resinous acid, this is considered to aid the effects 
of the oil in its action upon the renal epithelium, as well as 
upon the bronchial mucous membrane. This resin also is ex- 
creted in the urine and is precipitated by the addition of acids. 

Therapeutics of Cubeb. 
Cubeb is one of the drugs most commonly employed in the 
treatment of genito-urinary affections, especially gonorrhoea, 
gleet and chronic cystitis. It is considered most valuable in 
the acute stage of gonorrhoea. It often relieves functional irri- 
tability of the bladder, and sometimes checks nocturnal inconti- 
nence of urine. Some patients are peculiarly susceptible to its 
effects, and in them even small doses may produce gastric dis- 
turbance or vesical irritation, with bloody urine. In the treat- 
ment of affections of the respiratory passages it has a well- 



550 PHARMACOLOGY AND THERAPEUTICS. 

established position. Powdered cubeb, blown into the nostrils 
by an insufflator, is employed in chronic nasal catarrh, and is 
also sometimes an efficient local application in hay-asthma un- 
accompanied with fever and in follicular pharyngitis. The 
symptom asthma is often relieved by cubeb cigarettes, and these 
are useful also in sensitive hypertrophies of the nose and in 
mild bronchitis. The official troches are employed by vocalists 
and public speakers, and many popular bronchial troches con- 
tain cubeb. It is of considerable service in subacute or chronic 
bronchitis, especially when there is a profuse muco-purulent 
secretion. It is not much used as a stomachic or cardiac stim- 
ulant, on account of its liability to cause digestive disturbance, 
but in atonic dyspepsia its carminative effect on the stom- 
ach may sometimes be availed of by its cautious employment 
in small doses. Cubeb is of decided service in cases of 
chronic catarrh of the colon and rectum, with a relaxed condi- 
tion of the mucous membrane and of the inferior hemorrhoidal 
vessels, whether the affection assumes the form of mucous 
dysentery or not. In haemorrhoids it is less efficient than black 
pepper. 

OIL OF SANTAL. 

OLEUM SANTALL— Oil of Santal. (Oil of Sandal Wood.) Dose, 
0.5 c.c; 8 ni. 

Action of Oil of Santal. 

The action of the oil of santal closely resembles that of 
copaiba and cubeb, but it is less irritant, as well as more agree- 
able to take, than either of the others. Like them, it is a 
bronchial and genito-urinary stimulant and disinfectant. Its 
absorption and excretion are very rapid, and it appears in the 
urine in about half an hour after ingestion by the mouth. 
After daily doses of 4 c.c. (60 Ttl) irritation of the alimentary 
canal and urethra, with an eruption of small red papules upon 
the skin and conjunctiva, have been observed. 



OIL OF THYME. 55 I 

Therapeutics of Oil of Santal. 

It is best administered in capsules, or in an emulsion, and is 
much used in gonorrhoea and gleet. One objection to it is its 
expensiveness, and on account of its high cost it is frequently 
adulterated. The advantage of pure oil of santal over copaiba 
and cubeb is that it does not nauseate or disturb digestion, and it 
can be given with good results during the inflammatory stages 
of gonorrhoea or cystitis. In addition to these affections, it is 
of service in pyelitis, urethral haemorrhage, and bronchitis. 
Two or three drops on sugar will often be found to relieve the 
hacking cough with which there is little expectoration. 

MATICO. 
MATICO. — Matico. Dose, 4 gin.; 60 gr. 

Preparation. 
Fluidextractum Matico. — Fluidextract of Matico. Dose, 4 
c.c; 1 fl. dr. 

Unofficial Preparation. 
Oleum Matico. — Oil of Matico. Dose, 0.30 to 1.20 c.c.; 5 to 
20 TT1.. 

Action of Matico. 

The volatile oil of matico probably has much the same action 
as that of cubeb, influencing chiefly the genito-urinary passages. 

Therapeutics of Matico. 
It has been given for the same cases as cubeb, but is now 
rarely used. The leaves are sometimes placed upon a bleeding 
surface. Their numerous hairs promote the clotting of the 
blood, and thus they are haemostatic. 

OIL OF THYME. 
OLEUM THYML— Oil of Thyme. Dose, 0.2 c.c; 3 TT|.. 

Action of the Oil of Thyme. 
Its action is similar to that of copaiba. 



552 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of the Oil of Thyme. 
The chief use of oil of thyme is as a source of thymol. It 
has been employed in the treatment of bronchitis, gonorrhoea, 
gleet, leucorrhoea, and vesical catarrh. 

SACCHARIN. 

BENZOSULPHINIDUM.— Benzosulphinide. Saccharin. (Gluside.) 
Dose, 0.200 gm. (200 milligm.) ; 3 gr. 

Unofficial Preparation. 
Dulcinum. — Dulcin. (Sucrol. Para-phenetol-carbamide.) 
Dose, .03 to .12 gm.; y 2 to 2 gr., up to a daily maximum of 
2 gm.; 30 gr. 

Action of Saccharin. 

Saccharin is an antiseptic, but almost the only practical use 

which is made of it in this capacity is in the surgery of the 

bladder. Its principal use is as a sweetening agent. It is not 

a food, and is eliminated in the urine and saliva without change. 

Therapeutics of Saccharin. 

It is quite generally employed as a substitute for sugar when 
from any cause, as in diabetes mellitus, this cannot be taken. 
It may be used in tablets (for sweetening a cup of tea or coffee 
one-quarter to one-half grain is sufficient) or in the form of 
soluble saccharin, which is prepared by neutralizing a solu- 
tion of sodium bicarbonate with saccharin. It contains about 
90 per cent, of saccharin, and is soluble in 15 of water. An 
excellent elixir for covering the taste of nauseous medicines 
may be prepared as follows: Saccharin, 2; sodium bicarbon- 
ate (90 per cent.), 1; alcohol, 5; water, 35 parts. Saccharin 
is used as an internal antiseptic in cystitis with ammoniacal 
urine, and has been highly commended as a mouth-wash, in 
aphthae and a topical agent in ozsena. 

Dulcin (para-phenetol-carbamide) is a urea derivative of 
phenetidin, the sweetening power of which is about 200 times 
that of sugar. It is said not to give rise to the disgust en- 



DRUGS ACTING ON THE BODILY HEAT. 553 

gendered by saccharin on prolonged use, but it has the disad- 
vantage of great insolubility. It is soluble in 800 of water, 55 
of boiling water, and 25 of alcohol. It is said that 1 gm. (15 
gr.) will usually reduce the temperature in fever one degree 
centigrade in about three hours. 



Division VII. — Drugs Acting on the Bodily Heat. 

A. Antipyretics, or Drugs which decrease the Body Tem- 
perature. — With the exception of those which, when given in 
sufficient quantity to induce severe collapse may in this way 
cause the temperature to fall below normal, there are few drugs 
capable of reducing the temperature in health. The term anti- 
pyretic is therefore limited to such drugs as have the power of 
depressing the body temperature in fever. In health the tem- 
perature is maintained at a uniform point through a balance 
established between the production of heat (thermogenesis) 
and its dissipation (thermolysis) through the skin, lungs and 
other organs. The main source of production is the voluntary 
and involuntary contraction of the muscles, and the loss of 
heat occurs to some extent through the lungs, but chiefly by 
means of radiation from the cutaneous blood-vessels and the 
evaporation of perspiration. Now if an excessive formation 
of heat takes place, as during active muscular exertion, this is 
compensated for by an increased output from the skin, through 
the dilation of the vessels and by the perspiration. On the 
other hand, if there is an increased heat dissipation from ex- 
posure to cold, this is offset by an augmented combustion of 
the tissues, with the formation of more heat. In order to pre- 
serve a balance between the heat producing and heat dissi- 
pating agencies there must be present a coordinating mechan- 
ism, and there is considerable ground for locating this about 
the corpus striatum, in the basilar ganglia of the cerebrum. 
Lesions in this part of the brain are usually found to cause a 
very marked rise of temperature, and it is stated that in ani- 



554 PHARMACOLOGY AND THERAPEUTICS. 

mals no shivering is produced by cold after section of the cere- 
bral peduncles. The heat regulating function (thermotaxis) 
is more or less deranged by various poisons, and especially by 
such as are generated in fever. The existence of a heat-regu- 
lating centre in the brain, it may be stated, has never as yet 
been definitely proved, and some investigators believe that the 
vasomotor centre in the medulla oblongata is sufficient to ex- 
plain the normal coordination of formation and output. It has 
lately been suggested that the thyroid and suprarenal glands, 
one of which is thought to be perhaps the main organ of the 
body to provide vaso-dilating material, while the other fur- 
nishes the chief supply of vaso-constricting material, may play 
an important part, by their opposed action, in this alternate 
opening and shutting of the blood-vessels. As affording some 
support to this view, attention has been called to the fact that 
in the babe, which apparently has no heat governor or regula- 
tor, since its temperature varies with that of its surroundings, 
the thyroid is but imperfectly developed, while the suprarenal 
glands have been observed to contain no vaso-constricting 
material. 

Antipyretics which increase the loss of heat. — Among these 
are included all sudorifics and dilators of the cutaneous blood- 
vessels. Cold, as in the form of a cold bath, acts by direct 
abstraction of caloric. The action of salicylic acid and salicin 
in reducing temperature is probably explained by the vascular 
dilation caused and the increase in the output of heat. This 
is also now believed to be the case with drugs of the class to 
which acetanilide, antipyrine and phenacetine belong, so that the 
cells of the body grow and change less when removed from the 
high temperature to which they were previously exposed. 
Some investigators, however, regard the fall in heat formation 
as too great to be explained in this way, and infer that these 
antipyretics diminish the combustion through some other action, 
though not by affecting the tissues directly. 

Drugs wJtich probably diminish the production of heat. — 
Quinine apparently does this by lessening the metabolism. The 



DRUGS ACTING ON THE BODILY HEAT. 555 

antipyretic action of digitalis may perhaps be due to its causing 
an increased activity of the heat-regulating centre, as has been 
shown to be the case with picrotoxin and several other central 
nervous stimulants. The fall of temperature produced by anti- 
mony has been explained by the slowness of the circulation and 
by the general depression and profuse perspiration. The pre- 
cise manner in which aconite reduces the temperature is un- 
known. A cold bath not only abstracts heat, but if continued 
for a time diminishes its formation. Sometimes the removal 
of some reflex source of irritation may lower the temperature, 
and in this way purgatives occasionally act as antipyretics. 

Therapeutics. — Alcohol, spirit of nitrous ether, antimony, 
ipecacuanha and opium were formerly in constant use as anti- 
pyretics, but at present are not very often given to reduce fever. 
Cold is more often employed, either by cold sponging, ice, or a 
cold bath. Sponging with hot water will, by the vascular dila- 
tation and subsequent sweating it induces, reduce a febrile 
temperature. 

Of the drugs which are now used for this purpose, acetanilide 
and antipyrine are dangerous because of the collapse they may 
bring about, while quinine and salicylic acid are rather uncer- 
tain, except in ague and rheumatic fever respectively. Anti- 
pyrine is a very prompt and certain antipyretic, and, notwith- 
standing its dangerousness, it and phenacetine are most in de- 
mand. Phenacetine is less powerful, but quite safe, as a rule. 
Antipyretics, however, should be rarely given, as in sufficient 
doses to reduce the temperature they may cause dangerous 
depression. Fever is only a surface indication of the essential 
pathological condition, systemic infection, and if the pyrexia is 
not excessive, no special action is called for. When this is the 
case the external use of cold is generally preferable, since in 
addition to its antipyretic effect, it is likely to furnish a needed 
stimulus to the nervous system and prove beneficial in other 
ways. 

B. Drugs which cause a rise of Temperature. — Belladonna 
may have this effect. The cause is not definitely known, but it 



55^ PHARMACOLOGY AND THERAPEUTICS. 

has been attributed to direct action on the heat centres in the 
brain. The temperature is generally increased by poisonous 
doses of cocaine, also it is thought probable, from some disorder 
of the cerebral heat-regulating centres. Picrotoxin, like other 
convulsive poisons, may cause a rise of temperature when given 
in poisonous amounts. 

Tuberculin, various albumoses, and certain animal poisons, such as 
that of shell-fish, will cause a rise of temperature. Their mode of action 
is unknown. 

ANTIPYRETICS. 

ACETANILIDUM.— Acetanilide. (Phenylacetamide. Antifebrin.) 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparation. 
Pulvis Acetanilidi Compositus. — Compound Acetanilide Pow- 
der. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Action of Acetanilide. 

External. — It is antiseptic, haemostatic, and slightly sedative. 

Internal. — Blood. — Upon the red corpuscles it has the effect 
of causing the formation of methsemoglobin, and, in larger 
amounts, a disintegration of the corpuscles. The movements 
of the leucocytes are also arrested by it. The formation of 
methsemoglobin has been found to be much more pronounced 
inside than outside the body. The actions on the blood are 
decidedly weaker than in the case of phenol and other sim- 
ilar agents, but they occasion a peculiar cyanosis, which is 
much more intense than that caused by the formation of the 
same amount of methaemoglobin by other poisons. It is often 
accompanied by dyspncea and acceleration of the pulse, and 
lasts for periods ranging from a few hours to several days. 

Heart and Vessels. — The heart is at first accelerated and 
afterwards slowed, and this is attributed to the direct action 
of the drug upon the cardiac muscle. When a considerable 
reduction in temperature is caused, this also contributes largely 
to the slowing of the organ. The increased rhythm of the heart 
leads to a slight rise in the blood-pressure, but this falls as the 
pulse becomes slower. 



ANTIPYRETICS. 557 

Respiration. — This is not usually affected by ordinary doses, 
but under poisonous amounts it progressively fails. 

Kidneys. — Acetanilide has some diuretic property. Some 
observers consider it probable that in large doses it increases 
the excretion of uric acid, but others state that in health it has 
no effect on the excretion of this substance. After ordinary 
doses the urea and total nitrogen of the urine may be slightly 
augmented, and in large amounts it causes an increase in these 
of from 30 to 35 per cent., so that there is a large increase in 
the tissue waste. Acetanilide is rapidly absorbed and rapidly 
excreted by the kidneys. It undergoes a partial oxidation, but, 
except after very large doses, none of the original body appears 
in the urine. Some of it enters into combinations with sul- 
phuric and glycuronic acids, and the oxidation products often 
give a smoky color to the urine, especially after it has been 
exposed to the air for some time. After large doses the color 
of the urine may also be darkened in consequence of the pres- 
ence of methsemoglobin. After acetanilide, ferric chloride gives 
a reddish-brown tinge to the urine. 

Skin. — Diaphoresis may be produced in consequence of the 
increased cutaneous circulation, and in fever profuse sweating 
not infrequently follows its use. Sometimes an erythematous 
rash is caused which usually resembles that of measles. Occa- 
sionally urticaria occurs, and more rarely eczema and bullae, 
while in some instances an oedematous swelling is observed. 
Such skin affections, which are less frequently elicited by ace- 
tanilide than by antipyrine, may possibly be accompanied by 
some febrile reaction. 

Temperature. — Acetanilide has little effect upon the normal 
temperature, though it may cause a slight elevation unless the 
amount administered is sufficient to produce pronounced symp- 
toms of collapse. If the temperature is above normal, how- 
ever, it has a marked antipyretic effect, often reducing .it to 
below normal. It was at one time supposed that acetanilide and 
other drugs of- its class diminished the heat production in con- 
sequence of lessening the metabolism, in the same way as qui- 



55$ PHARMACOLOGY AND THERAPEUTICS. 

nine. It is now known, however, that such is not the case, and 
it is held that the seat of their action is the base of the cere- 
brum. As to the modus operandi of these antipyretics, it is 
believed that they effect the reduction of pyrexia through alter- 
ations produced in the heat-regulating mechanism which result 
in lowering the point at which the temperature is maintained. 
Consequently, a great increase in the dissipation of heat must 
take place in order to get rid of the warmth that has accumu- 
lated in the body, and this augmented output is attained by 
dilatation of the cutaneous blood-vessels. Their principal ac- 
tion practically, therefore, is by causing an increased heat loss 
through this vascular effect, by reason of which a large amount 
of blood is exposed to the cold air. It has been shown experi- 
mentally that the dilatation of the cutaneous vessels is suffi- 
ciently marked to be recorded by the plethysmograph in many 
instances, while in others flushing of the skin is observed. 
There is also a lessened heat production, but this is found to 
be much less important, and is now generally regarded as due 
to the fact that, at the lower temperature caused, metabolism 
goes on less actively. The decrease in metabolism is really, 
then, an effect, and not a cause, of the fall of temperature. The 
degree of antipyretic action produced by these drugs is thought 
to depend to a great extent on the functional activity present 
in the centres, as it is found that there is a difference in the 
susceptibility of different fevers to the action of such agents; 
high continuous fevers reacting least, and those of an intermit- 
tent type being most amenable. Acetanilide, and its group, 
therefore, possesses anti-periodic properties, and in malarial 
fever the greatest effect is always produced when the action 
falls in the period of the natural decline of temperature. 

Nervous System. — The action on the central nervous system, 
aside from that on the heat-regulating centre, consists m stimu- 
lation followed by paralysis, and a narcotic, a convulsant, and 
a collapse effect, which pass insensibly into each other, have 
been described. Its narcotic action renders acetanilide a power- 
ful analgesic, although the narcosis is only slight and not at 



ANTIPYRETICS. 559 

all comparable to that of the true narcotics, since cerebral ac- 
tion may be induced by small doses which do not apparently 
influence the mental activity. As the influence of ordinary 
doses upon the nerve cells appears to be very slight, it has been 
suggested that the action may perhaps be confined to some spe- 
cial areas of the brain. The convulsions produced by large 
doses are stated to be intermittent in character and preceded 
by increased reflex irritability. In the frog the excitability of 
the spinal cord may lead to convulsions, but in mammals the 
origin of the convulsions is not clearly understood. In general, 
they appear to be referable to the cerebrum, but it is thought 
possible that in some cases they may not be due to the direct 
action of the poison on the brain, but are rather asphyxial in 
character and dependent upon the changes in the blood, circu- 
lation and respiration. In ordinary poisoning the peripheral 
nerves and nerve ends do not seem to be seriously involved, 
and in both frogs and mammals the final paralysis is consid- 
ered to be undoubtedly central. The convulsive stage is fol- 
lowed by unconsciousness, collapse, and total paralysis. The 
pulse, at first accelerated, becomes slowed, and the respiration 
is dyspnceic and then diminished. The skin is cyanotic and 
covered with cold sweat, and sometimes there are vomiting 
and dilatation of the pupils. Symptoms of collapse are occa- 
sionally produced in susceptible persons by medicinal doses, and 
especially if these are large, though death has been known to 
occur after only .30 gm. (5 gr.) in one instance. In this, how- 
ever, it is possible that the drug may have been impure. In the 
milder cases the skin is cool and the pulse rather small and rapid, 
but the condition soon passes off. In severe cases the skin is 
cold and covered with a clammy sweat, the heart is weak, irreg- 
ular, and sometimes fluttering, and the body temperature may 
be subnormal. The weakness of the heart is the principal source 
of anxiety, and the total failure of the circulation seems to be 
the cause of death. These cases of collapse occur more fre- 
quently when a rapid fall of temperature has been produced 
than under other circumstances, but may be observed in per- 



560 PHARMACOLOGY AND THERAPEUTICS. 

sons who have had no fever. The collapse sometimes appear- 
ing after small doses in fever, it has been suggested, may be 
due, not to the drug, but to the reduction of the temperature. 
In such cases, it is claimed, there was a pre-existing collapse, 
which was masked by the hyperpyrexia, the effects of which 
are in certain ways antagonistic to those of collapse. When, 
therefore, the stimulus of the high temperature is removed, the 
hidden collapse becomes apparent. Notwithstanding its insolu- 
bility, acetanilide is said to have been absorbed from wounds in 
sufficient amount to produce toxic symptoms. 

Untoward Action. — In addition to the collapse and to the 
cutaneous eruptions or the cyanosis which occasionally follow 
medicinal doses of acetanilide, may be mentioned certain other 
untoward effects: digestive disturbances, symptoms resembling 
cinchonism, and paroxysms of sneezing. Under prolonged use 
of the drug congestion of the liver, spleen and kidneys is said 
to occur. 

Therapeutics of Acetanilide. 

External. — Acetanilide has been used with advantage as a 
dusting powder for soft and hard venereal ulcerations, in place 
of iodoform, and in the form of an ointment (1 to 24) for 
chronic ulcers, eczema, urticaria, erysipelas, and other affec- 
tions associated with, considerable irritation. It has also been 
employed as an antiseptic for wounds. Too large a surface, 
however, should not be dusted over. 

Internal. — Pyrexia. — Acetanilide was originally introduced as 
a rival to antipyrine on account of its powerful antipyretic 
action in fever, and it is still used to some extent for the reduc- 
tion of temperature. The opinion is gaming ground, however, 
that if the temperature is not very high no attempt should be 
made to reduce it, as there is then no danger from this source, 
and, moreover, the theory is still held by some that fever is a 
defensive measure taken by the organism against the causes of 
disease. The principal objection to the use of acetanilide and 
other similar drugs is the cardiac depression which they are 
liable to induce, and hence in exhausting diseases like the con- 



ANTIPYRETICS. 56 1 

tinued fevers they may prove distinctly dangerous. By most 
physicians of the present day, therefore, it is deemed safer, as 
well as preferable in some other respects, to use cold baths or 
some of the modifications of the Brand treatment whenever 
the temperature reaches such a point that the hyperpyrexia is 
dangerous to life. If it is decided to use antipyretics acetani- 
lide will often produce a rapid reduction of temperature. The 
minimum is reached in about two hours, and the effect may 
continue for a considerable time. This action does not persist 
after the drug is excreted, however, and hence the administra- 
tion must be a continuous one, although if it is given when the 
fever is just beginning to rise again, smaller doses are required 
than at first. Of the more usual antipyretics, acetanilide pro- 
duces probably the strongest collapse effects, and it is found 
not to keep the temperature down quite so long as some other 
remedies of its class. As it has no direct action upon the intes- 
tinal tract, it may be administered by the rectum when this 
seems desirable. 

Analgesic Action. — Acetanilide is frequently useful in reliev- 
ing the pain of neuralgia, sciatica, dysmenorrhoea, locomotor 
ataxia, migraine, and various headaches. 

Under the name of Antikamnia a substance has been intro- 
duced that is probably a mixture of 20 parts of sodium bicar- 
bonate, 70 of acetanilide and 10 of caffeine; which is the com- 
position of the new official compound acetanilide powder. Since 
acetanilide is a cardiac depressant, the addition of caffeine is 
advantageous in most instances, though a case of death has 
been reported which was attributed to the ingestion of 1.50 
gm. ; 24 gr. of this mixture. Antinervine contains acetanilide, 
sodium salicylate and potassium bromide. 

Ammonol is a proprietary antipyretic and analgesic, claimed 
to possess unusual stimulating and expectorant properties in 
consequence of the ammonia in its composition. It is believed 
to be merely an admixture of acetanilide, 2 parts ; sodium bicar- 
bonate, 1 ; and ammonium carbonate, 1 part ; with a minute 
quantity of the dye, metanyl-yellow. A similar mixture is in 

37 



562 PHARMACOLOGY AND THERAPEUTICS. 

use at the Philadelphia Hospital, consisting of acetanilide, 5; 
sodium bicarbonate, 3; ammonium carbonate, 2. 

TOXICOLOGY. 
When collapse symptoms are caused by acetanilide the treatment con- 
sists in stimulation, as in collapse from other causes. General stimula- 
tion is called for by alcohol and ether, given subcutaneously or by the 
mouth, or in both ways, and stimulation of the heart by the subcu- 
taneous injection of strychnine. Oxygen inhalations may also be of 
service, and hot applications should be made to the extremities and body. 

ANTIPYRINE. 

ANTIPYRINA.— Antipyrine. (Phenazonum, B. P. Phenyldimethyl- 
pyrazolon.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 

Iodopyrinum. — Iodopyrine. — (Iodantipyrine.) Dose, 0.40 to 
2 gm.; 6 to 30 gr. 

Migraninum. — Migranine. Dose, 1 gm.; 15 gr. 

Pyramidonum. — Pyramidon. (Dimethyl - ami do - antipyrine.) 
Dose, 0.25 to 0.50 gm.; 4 to 8 gr. 

Salipyrinum. — Salipyrine. (Antipyrin Salicylate.) Dose, 0.40 
to 2 gm.; 6 to 30 gr. 

Action of Antipyrine. 
Antipyrine in small doses may moderately increase arterial 
pressure by direct stimulation of the heart; in large doses it is 
a cardiac depressant, the final fall of blood-pressure being cer- 
tainly due, at least in part, to a direct action upon the heart. 
It is mildly antiseptic, and will preserve blood for some days 
when added to it so as to form a 2 to 5 per cent, solution. It 
is also haemostatic, having the property of coagulating proteids. 
Like acetanilide, it is somewhat diuretic, and it is excreted in 
great part unchanged in combination with sulphuric acid and 
perhaps with glycuronic acid. After antipyrine has been taken 
the addition of ferric chloride to the urine gives a red color. 
It is a local anaesthetic, but irritation has followed its hypoder- 
matic use. It may produce an erythematous or other rash. It 



ANTIPYRINE. 563 

rapidly reduces an elevated temperature in the same way as 
acetanilide. In large doses it is said to produce convulsions; 
later, coma and paralysis of motor nerves and muscles. 

Therapeutics of Antipyrine. 

Antipyrine is given internally as a powerful antipyretic, in 
fevers of various kinds. It is also used as a haemostatic in 
haemorrhoids and epistaxis. It has been given with some suc- 
cess in diabetes. It is largely employed as an anti-neuralgic, 
relieving the pains of locomotor ataxia and other nervous affec- 
tions, and as an anti-rheumatic. It has been highly recom- 
mended in chorea and epilepsy. 

Salipyrine is prepared by the action of antipyrine upon sali- 
cylic acid in substance. It is a white, coarsely-crystalline pow- 
der with a rather sweetish taste, readily soluble in alcohol and 
but slightly in water. In chronic articular rheumatism and sci- 
atica it may prove of service, but it does not prevent relapses. 
It has been successfully used for spasmodic dysmenorrhcea. 

Iodopyrine, or iodantipyrine, is supposed to have a hydrogen 
atom in the phenyl group of antipyrine replaced by iodine. It 
occurs in colorless, prismatic needles, which are tasteless. It 
is with difficulty soluble in cold water or alcohol, but readily 
in hot. It causes a fall of temperature and considerable dia- 
phoresis, but it is doubtful if it has any advantage over anti- 
pyrine. 

Migranine is a double citrate of antipyrine and caffeine which 
is stated to be efficacious in sick headache and neuralgia. 

Pyramidon, dimethyl-amido-antipyrine, is a derivative of 
antipyrine by a substitution process, which occurs as a yellow- 
ish-white crystalline powder, soluble in 10 parts of water. As 
compared with antipyrine, with which it has the same general 
action, it is less soluble and acts with less promptness, but its 
effects are more lasting, and the same results are said to be 
produced with about one-third the dose. As an antipyretic it 
has been highly praised in the fever of tuberculosis, in acute 
articular rheumatism, and in typhoid fever. It is claimed that 



564 PHARMACOLOGY AND THERAPEUTICS. 

when properly administered it has no deleterious effect upon the 
blood or the digestion, and that it exerts a beneficial rather than 
an unfavorable action upon the heart. As an analgesic and 
anti-neuralgic it has been given with considerable success in 
the pains of locomotor ataxia, in migraine, and in intercostal, 
trigeminal, and other neuralgias. 

TOXICOLOGY. 
While antipyrine is somewhat less liable to such action, it occasionally 
produces collapse effects in the same way as acetanilide. The treat- 
ment of the depression caused by it is the same as in the case of the 
latter. Antipyrine has been credited with a considerable number of 
deaths, but it is quite likely that most of them have been due to im- 
proper dosage. 

ACETPHENETIDIN. 

ACETPHENETIDINTJM.— -Acetphenetidin. (Phenacetine.) Dose, 
0.500 gin. (500 milligm.) ; 7V2 £*- 

Action of Acetphenetidin. 
Acetphenetidin, or phenacetine, as it has hitherto been 
known, has no action externally nor on the gastro-intestinal 
tract, and with ordinary doses the blood is unaffected. It 
slightly depresses the heart, but does not in ordinary doses 
affect the respiration. It is a mild diuretic, and large doses 
cause the passage of altered blood. It is a powerful antipyretic, 
by increasing heat dissipation and also diminishing heat pro- 
duction to some extent. It is likewise a powerful analgesic. 

Therapeutics of Acetphenetidin. 

It is a valuable remedy for reducing fever, and, because it 
depresses the heart but little, it is safer than either antipyrine 
or acetanilide. It is, however, very insoluble, and slower and 
less powerful than these remedies, though its effects last longer. 
Since it possesses a very marked analgesic action, acetpheneti- 
din is to be preferred as a remedy for the relief of pain, as in 
neuralgia, sciatica, locomotor ataxia, migraine and various 
headaches. For this purpose, the dose of .30 gm. (5 gr.) should 



LACTOPHENINE. 565 

be administered every hour for three or four hours ; when relief 
generally results. This drug has been of service in the treat- 
ment of epilepsy. 

TOXICOLOGY. 
Symptoms. — Acetphenetidin sometimes produces severe vomiting, 
sweating, feeble and rapid pulse, and collapse. Treatment. — Alcoholic 
stimulation. Strychnine hypodermatically. External warmth. 

EXALGIN. 

Unofficial Preparation. 
Exalginum. — Exalgin. (Methyl Acetanilide.) Dose, 0.03 to 
0.20 gm.; y 2 to 3 gr. 

Action of Exalgix. 
It has the general action of the antipyretics. In medicinal 
doses it rarely causes depression, but large amounts, since they 
are capable of causing disintegration of the red blood-corpus- 
cles, may prove dangerous. 

Therapeutics of Exalgix. 
Exalgin is an excellent analgesic, and not infrequently gives 
relief when various other drugs have failed. It may be advan- 
tageously dissolved in Tinctura Aurantii Dulcis, but is often 
given in pill or tablet form. It is used for migraine., sciatica, 
the pains of rheumatism, and, of late, for chorea. 

TOXICOLOGY. 

Several severe cases of poisoning having been reported, the usual dose 
should not be exceeded. The symptoms are similar to those of ace- 
tanilide. 

Treatment. — As for acetanilide. {See p. 562.) 

LACTOPHENINE. 

Unofficial Preparation. 
Lactopheninum. — Lactophenine. (Lactylparaphenetidin.) 

Dose, 0.60 to 1 gm.; 10 to 15 gr. 



566 PHARMACOLOGY AND THERAPEUTICS. 

Action of Lactophenine. 

Lactophenine is an analgesic and antithermic. It is usually 
better borne than antipyrine. Although it may, in some in- 
stances, give rise to sweating, it does not cause collapse nor 
cyanosis. It produces a considerable and persistent lowering 
of a febrile temperature, but without abundant perspiration, and 
its use is not followed by chilly sensations. 

Therapeutics of Lactophenine. 

It has been administered in articular rheumatism, influenza, 
scarlet fever, septicaemia and other infectious diseases. Excel- 
lent results have been reported from it in typhoid fever, with 
daily doses from 0.50 to 1 gm. (7 to 15 gr.), not only in reduc- 
ing the fever, but as a sedative when delirium becomes a promi- 
nent symptom. 

PHENOCOLL HYDROCHLORIDE. 

Unofficial Preparation. 
Phenocolli Hydrochloridum. — Phenocoll Hydrochloride. Dose, 
0.30 to 2 gm.; 5 to 30 gr. 

Action of Phenocoll Hydrochloride. 

It is not poisonous to animals, nor does it injuriously affect 
the blood. It is a fairly powerful antipyretic, not followed by 
collapse or cyanosis; the perspiration is not more marked than 
after large doses of antipyrine. It is rapidly excreted by the 
urine, to which it gives a brownish color, and it probably in- 
creases the excretion of uric acid. 

Therapeutics of Phenocoll Hydrochloride. 
In addition to its use as an antipyretic it has been employed 
as an antineuralgic, while in severe acute articular rheumatism 
it has exercised a beneficial action upon the joints when other 
remedies have failed. The reports, of which there are now a 
considerable number, are favorable to this remedy. 



DRUGS ACTING ON THE RESPIRATION. 567 

Unofficial Preparation. 
Thallinae Sulphas.— Thalline Sulphate. Dose, 0.12 to 0.60 
gin.; 2 to 10 gr. 

Action of Thalline Sulphate. 
This drug was introduced into medicine as an antipyretic, 
but it was soon abandoned because of the dangerous collapse, 
with marked cyanosis, which it produced. It is rarely given 
internally, because it is poisonous to the red blood-corpuscles 
and to the nervous system. 

Therapeutics of Thalline Sulphate. 
Its chief use is as an injection for gonorrhoea, in aqueous 
solution ( 1 or 2 to 120), or it can be used in a 2 per cent, 
solution in gelatin bougies. In gleet beneficial results have 
followed the injection of 1 to 8 aqueous solutions. 



Division VIII. — Drugs Acting on the Respiration. 

The influences affecting the respiration are so numerous and 
varied that it is not always easy to determine the precise mode 
of action of any drug which produces an impression upon it. 
Thus, the respiratory centre in the medulla (which is subject 
to direct or reflex influences from almost all the organs of the 
body), the movements of the respiratory muscles, or the circu- 
latory mechanism influencing the respiration may be acted 
upon; or, again, alterations produced in the blood or in the air 
respired may affect the function. In therapeutics, however, the 
object is generally to remove the cause of or alleviate respira- 
tory difficulty, rather than act upon the respiration itself. 
Drugs which produce changes in the blood and circulation have 
already been considered, while for the consideration of such 
modifications of the temperature, moisture and atmospheric 
pressure as are of service reference must be made to works on 
general therapeutics. Therefore, the respiratory drugs will 
now be treated of under the following heads : 



568 PHARMACOLOGY AND THERAPEUTICS. 

A. Drugs altering the Composition of the Air inhaled. — In 

this come drugs which, when inhaled, have some direct effect 
on the respiratory mucous membrane, or the bronchial and 
pulmonary contents, and may also have remote effects. Certain 
drugs, although they are not employed for their effects on the 
respiration, are most conveniently administered by inhalation; 
e. g., anaesthetics and amyl nitrite. 

Some drugs when inhaled produce very marked irritation of 
the bronchial mucous membrane, thus giving rise to vascular 
dilatation and augmented secretion, and reflexly causing cough 
from stimulation of the sensory nerves of the part. 

Such are iodine, bromine, chlorine, senega, ipecacuanha, sulphurous 
anhydride, nitric acid fumes, ammonia, and tobacco, as well as cold 
dry air. These are rarely used therapeutically as inhalations, and their 
inhalation is to be particularly avoided in irritable conditions of the 
bronchi. 

The drugs which, when inhaled, are soothing to the bron- 
chial mucous membrane, but are rarely employed, are — 

Hydrocyanic acid. Conium. 

Inhalations which are used to stimulate the bronchi, that is 
to say, to increase their vascularity, secretion, and muscular 
power, are — 



(i) Phenol 1 1.20C.C. (4) Tincturaben- 

(2) Oil of cajuput I (20 TTt ) . zoini composita, 

(3) Oleum pini sylvestris, 2 c.c. (5) Creosote, 

(30 TTL). (6) Oil of cubeb. 



15 c.c. (fl 3 SS )- 



The amounts given after each are the quantities that should be added 
to 500 c.c. (1 pint) of water at 6o° C. (140 F.). 

Inhalations which are used to disinfect foul secretions from 
the bronchial mucous membrane are those of — 



(1) Creosote. 

(2) Iodoform. 

(3) Mild solutions of benzoin. 

(4) Phenol. 



(5) Sulphurous anhydride. 

(6) Oil of juniper. 

(7) Oil of cubeb. 

(8) Oil of eucalyptus. 



DRUGS ACTING ON THE RESPIRATION. 



569 



Inhalations for relieving spasm of the bronchial tubes are 
those of — 



(1) Conium. 

(2) Stramonium. 

(3) Chloroform. 



(4) Ether. 

(5) Amyl nitrite. 



B. Drugs acting on the Respiratory Centre. — If, when in- 
jected into the carotid artery, a drug produces a very prompt 
effect on respiration, it is concluded that it acts on the respira- 
tory centre. In order to determine whether the drug acts on 
the centre, or on the vagal terminations in the lung, it is cus- 
tomary to divide the vagi and then observe whether it acts in 
the same way after, as before, the section. 

Drugs which directly stimulate the respiratory centre are — 



(1) Strychnine. 

(2) Ammonia (very power- 

ful). 

(3) Apomorphine. 



(4) Belladonna. 

(5) Stramonium. 

(6) Hyoscyamus. 



Drugs which depress the respiratory centre are — 



(1) Physostigmine (very 


(9) Aconite. 


powerful). 


(10) Veratrine. 


(2) Hydrated chloral. 


(11) Conium. 


(3) Chloroform. 


(12) Caffeine. 


(4) Ether. 


(13) Quinine. 


(5) Alcohol. 


(14) Ipecacuanha. 


(6) Opium. 


(15) Antimony salts (very 


(7) Hydrocyanic acid. 


weak). 


(8) Codeine. 





Alcohol, ether, chloroform, caffeine, and quinine slightly excite, be- 
fore they depress, the respiratory centre. 

Therapeutics. — Drugs exciting the respiratory centre may be 
given when there is any difficulty in respiration for the purpose 
of increasing the force of the respiratory act; at the same time 
measures should be employed to remove the cause of the diffi- 



5/0 PHARMACOLOGY AND THERAPEUTICS. 

culty. They are, naturally, most frequently required in respir- 
atory diseases, and especially bronchitis. Ammonia and apo- 
morphine are very frequently prescribed for the reason that 
they are also powerful expectorants, and belladonna is applica- 
ble in cases with excessive bronchial secretion. 

Drugs which depress the respiratory centre are very seldom 
required for this action; but the centre for the reflex act of 
coughing is in the immediate vicinity of the respiratory centre, 
and opium, morphine, codeine, heroine, hydrocyanic acid, co- 
nium, and ipecacuanha are often very valuable in allaying the 
continual hacking cough frequently accompanying disease of 
the heart and lungs. 

The drugs which relieve cough are very numerous, since this 
may be reflexly set up by irritation of so many peripheral parts, 
viz., nose, throat, pharynx, ear, teeth, larynx, trachea, bronchi, 
lungs, pleura, stomach, and liver; and consequently its success- 
ful treatment may depend upon the removal of peripheral irri- 
tation in any of them. 

C. Drugs affecting the Bronchial Secretion. 

(a) Those increasing it: 



(i) Apomorphine. 






(9) Camphor. 


(2) All alkalies, 


especially 


am- 


(10) Benzoin. 


monium carbonate 


and 


(11) Balsam of Peru. 


other ammonium salts. 




(12) Balsam of Tolu. 


(3) Cocillana. 






(13) Antimony salts. 


(4) Ipecacuanha. 






(14) Sulphur. 


(5) Senega. 






(15) Iodine. 


(6) Squill. 






(16) Tobacco. 


(7) Turpentine. 






(17) Pilocarpus. 


(8) Terebene. 






(18) Many volatile oils 



It is probable that volatile oils and substances containing them de- 
crease the amount of bronchial secretion as a later effect. 

(b) Those decreasing it: 

(1) Acids. (3) Stramonium. 

(2) Belladonna. (4) Hyoscyamus. 



DRUGS ACTING ON THE RESPIRATION. 57 1 

Many authorities believe that under some circumstances alkalies de- 
crease the secretion. 

(c) Those disinfecting it: — Drugs which, when inhaled, act in this 
way have already been mentioned. Copaiba, cubeb, eucalyptus, and 
many volatile oils are excreted partly by the bronchial mucous mem- 
brane, and thus will disinfect the secretion. 

Therapeutics. — In bronchitis, remedies which increase the 
secretion are used when the latter is so viscid that it adheres 
to the tubes and cannot be coughed up; and those which de- 
crease it are employed when it is too watery to be easily expec- 
torated. The use of the disinfectants is obvious. 

D. Drugs relaxing Spasm of the Muscular Coat of the Bron- 
chial Tubes, or Antispasmodics. — It is believed that the symp- 
tom asthma is due to a spasmodic contraction of the bronchial 
tubes, and as — 



(1) Stramonium 

(2) Belladonna 

(3) Hyoscyamus 



(4) G-rindelia 

(5) Aspidosperma 



relieve this symptom, it is concluded that these drugs relax 
spasm of the muscular coat of the bronchial tubes. Stramo- 
nium is the most powerful. From their analogous action in 
other parts of the body, it is probable that the following drugs 
act in the same way: 

Chloroform, ether, opium, hydrated chloral, cannabis indica, amyl 
nitrite, and conium. 

Therapeutics. — Stramonium is of great use for relief of the 
symptom asthma, and this and the other drugs may be employed 
for cases of bronchitis in which spasm of the tubes seems to 
result from the inflammation present. Many of these muscu- 
lar depressants in all probability depress the nerves at the same 
time. 

E. Drugs acting on the Vessels of the Bronchi. — These are 
the same as have been already described (p. 324) as acting on 
the vascular system generally. 



57 2 PHARMACOLOGY AND THERAPEUTICS. 

F. Expectorants. — On account of the complexity of the 
modes of action of drugs affecting the respiratory system, it is 
customary to regard most of them clinically: simply as drugs 
which hinder or aid the expectoration of the contents of the 
bronchial tubes. Those which aid it are divided into two 
groups, named after their action, not on the lungs, but on the 
circulation. 

i. Stimulating expectorants. — These are stimulants to the circulation 
generally. They are — 



(i) Acids. 


(9) Balsam of Peru. 


(2) Ammonium salts. 


(10) Turpentine preparations 


(3) Cocillana. 


(n) Terebene. 


(4) Senega. 


(12) Oleum Pini Sylvestris. 


(5) Squill. 


(13) Nux Vomica. 


(6) Benzoin. 


(14) Sulphur. 


(7) Benzoic acid. 


(15) Quillaja. 


(8) Balsam of Tolu. 





2. Depressing expectorants. — These depress the general circulation. 
They are — 



(1) Alkalies. 

(2) Antimony salts. 

(3) Ipecacuanha. 

(4) Lobelia. 



(5) Pilocarpus. 

(6) Apomorphine. 

(7) Potassium iodide. 



Therapeutics. — It is almost impossible to lay down any gen- 
eral directions. In any case before us we must consider the 
acuteness or the reverse of the disease and whether we wish 
to stimulate or to depress the circulation, to increase, to 
diminish or to disinfect the expectoration, to stimulate the 
respiratory centre, to overcome spasm of the bronchial tubes, 
or to allay a hacking cough; and then employ such remedy or 
combination of remedies as seems best to meet the indications 
present. Warmth to the chest and warm drinks are sedative, 
and increase the amount of secretion, while cold and cold drinks 
have an opposite effect. 



HYDROCYANIC ACID. 573 

G. Drugs which in Man sometimes produce Cheyne- Stokes 
Breathing. — These are morphine, potassium bromide, and 
hydrated chloral. In animals the following, in addition, may do 
it: picrotoxin, muscarine, digitalin, strychnine and ammonium 
carbonate. 

B. Drugs Acting on the Respiratory Centre. 
HYDROCYANIC ACID. 

POTASSII FERROCYANIDUM.— Potassium Ferrocyanide. (Yel- 
low Prussiate of Potash.) Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

POTASSII CYANIDUM.— Potassium Cyanide. Dose, 0.010 gm. 
(10 milligm.) ; y 5 gr. 

Preparation. 
Acidum Hydrocyanicum Dilutum. — Diluted Hydrocyanic 
Acid. (Prussic Acid.) Dose, 0.1 c.c; iy 2 "HI- 

Action of Potassium Cyanide and Diluted Hydrocyanic 

Acid. 

External. — Hydrocyanic acid is a violent protoplasmic poi- 
son, and is toxic to all forms of life. It inhibits fermentation 
and putrefaction, and retards the growth of plants and the 
movement of animal cells. The diluted acid, when applied to 
the unbroken skin, is at first slightly irritating, but, as it 
penetrates the epidermis, it soon causes paralysis of the sensory 
nerve-endings, and thus has a sedative and anaesthetic effect. 
From raw surfaces it is very rapidly absorbed, and toxic effects 
may result from this absorption. Potassium cyanide may pos- 
sibly give the same results. It also produces a dermatitis on 
local application to the epidermis. 

Internal. Alimentary Tract. — Hydrocyanic acid is quickly, 
and potassium cyanide less rapidly, absorbed by mucous mem- 
branes, and on the fauces, oesophagus and stomach the same 
sedative and anaesthetic effects are produced as upon the skin. 

Blood. — Under the influence of hydrocyanic acid the tissues 
are unable to absorb the oxygen brought to them by the blood 
cells; in consequence, the oxyhaemoglobin of the blood is not 



574 PHARMACOLOGY AND THERAPEUTICS. 

reduced in the capillaries, and the venous blood, therefore, has 
the same bright red color as the arterial. Lactic acid and sugar, 
which are always present when the oxidation of the tissues is 
imperfect, are found in the blood in unusually large quantities 
during the action of hydrocyanic acid. In the body the acid 
does not enter into any combination with the haemoglobin of 
the red corpuscles. Blood to which it has been added retains 
its red color much longer than ordinary blood, and it is 
thought by some observers that the reason for this is that the 
acid destroys some oxidizing substance or ferment in the blood. 
Whenever hydrocyanic acid and methaemoglobin come in con- 
tact, a combination is formed (cyanomethsemoglobin) which is 
distingushed from ordinary methsemoglobin by having a bright 
red color; and in cases of cyanide poisoning the dependent 
parts of the body are often found to present such a tinge in 
consequence of this action on the methsemoglobin which they 
contain after death. The blackness of the blood which is 
observed in the internal organs is believed to be simply the 
result of the rapid death, such as is met with after any sudden 
death in well-nourished persons; the tissues being still alive 
after the stoppage of the circulation, and using up all the 
oxygen contained in the blood. 

Heart and Circulation. — The circulation is altered mainly 
through the action on the central nervous system, but the drug 
also acts directly on the heart. The pulse is apt to be slowed 
from the primary stimulation of the inhibitory centres, while 
the increased activity of the vaso-constrictor centres occasions 
a very considerable rise in blood-pressure. This central stimu- 
lation is succeeded by paralysis, in consequence of which the 
blood-pressure falls very low, but the movements of the heart 
generally remain slow, notwithstanding the cessation of the 
inhibitory stimulation, since the cardiac muscle is now directly 
affected by the depressing action of the drug. It is found that 
if very large quantities are injected intravenously or inhaled, 
the heart may cease contracting for a few seconds, and then 
recommence a slow and feeble beat, which is quickly arrested 



HYDROCYANIC ACID. 575 

again. This is thought to be due to primary action on the 
inhibitory centre, followed by direct paralysis of the heart. 

Respiration. — The respiratory changes are caused by primary 
stimulation and subsequent paralysis of the medullary centre. 
After very large quantities the respiration may cease within 
a few seconds. Under the use of smaller doses it is rendered 
quicker and deeper at first. It then becomes irregular, subse- 
quently grows very slow and deep, and finally ceases. 

Nervous System and Muscles. — The central nervous system 
is primarily stimulated and then depressed and paralyzed, and 
the medulla oblongata and lower portions of the brain are 
at first much more profoundly affected than the cerebral cortex, 
although the final paralysis apparently includes all parts of 
the central axis. When the drug is given in doses small enough 
to permit of watching its action, it is found that this com- 
mences in the medulla, where the vaso-motor, respiratory, 
vagus, vomiting and pupil-dilator centres are all stimulated. 
Then unconsciousness results, and after this convulsions, which 
in man are believed to be chiefly medullary in origin. Finally, 
paralysis of the whole central nervous system ensues, and in- 
voluntary evacuations of faeces, urine and semen are frequently 
observed. During the convulsions, which are rare in man but 
common in animals, there is generally a temporary rise in 
blood-pressure, and the respiration is naturally very irregular. 
Death is due to arrest of the respiratory function, the heart 
continuing to beat for a short time. The phenomena of the 
action of hydrocyanic acid on the central nervous system, it will 
be seen, are very much like those of asphyxia, and it is regarded 
as probable that the latter plays an important part in their 
production, though the rapidity of their development indicates 
that they cannot be attributed entirely to asphyxia. The peri- 
pheral nerves and muscles, when suspended in an atmosphere 
of hydrocyanic acid, are weakened and eventually paralyzed; 
but in the living animal, unless large amounts of the drug are 
injected, are found to be not much affected. 

Excretion. — Hydrocyanic acid is rapidly decomposed in the 



57^ PHARMACOLOGY AND THERAPEUTICS. 

body. Part of it combines with sulphur-containing molecules 
to form sulphocyanides, and is excreted as such in the urine, 
while part undergoes further changes which are as yet un- 
known. 

Therapeutics of Potassium Cyanide and Diluted Hydro- 
cyanic Acid. 

External. — Hydrocyanic acid is a valuable antipruritic. The 
official preparation should always be well diluted, and lotions 
of a strength of about 1 to 48 may be applied, to allay itching 
from almost any cause. They should not be employed in any 
case where the skin is broken. 

Internal. — Hydrocyanic acid may be administered as the 
official diluted acid, oil of bitter almond (3 to 14 per cent, of 
acid), bitter almond water, cherry laurel water (B. P.), the 
fluidextract, infusion and syrup of wild cherry, and as potas- 
sium cyanide. Reference should be made to each of these. In 
small doses the diluted acid, on account of its sedative and an- 
aesthetic effect, is often useful in relieving vomiting or gastric 
pain, and in many instances it may be administered most ac- 
ceptably in an effervescing draught. Since the effect of the 
remedy is transient, it should be given at frequent intervals. 
Enteralgia also not infrequently yields promptly to hydrocyanic 
acid. It is sometimes employed with advantage to allay cere- 
bral irritation and excitement. The giddiness of Meniere's 
disease (auditory nerve vertigo) is sometimes benefited by 
it, and it may prove useful in relieving the nervous palpita- 
tion met with in some cases of organic disease of the heart 
and also attacks of palpitation occurring as a symptom of 
a nervous condition in patients not affected with cardiac 
disease. It has been given in whooping-cough, and is very 
serviceable for the nervous cough of mothers which is not 
uncommonly observed in those whose children are suffering 
from this disease. It is used to a considerable extent as an 
ingredient of cough mixtures, on account of its effect in dimin- 
ishing reflex excitability by reason of its depressing action on 



HYDROCYANIC ACID. 577 

the central nervous system, and is especially valuable where 
there is a dry, hacking cough, without expectoration. Inhala- 
tions of a solution containing about .20 c.c. (3 Til) of diluted 
hydrocyanic acid to 250 c.c. (8 fl. oz.) of water, at a tempera- 
ture of 48. 8° C. (120 F.), are sometimes given with benefit in 
asthma and the irritative cough of phthisis. The uses of potas- 
sium cyanide are similar to those of hydrocyanic acid. 

TOXICOLOGY. 

The great danger from hydrocyanic acid is the rapidity of its action, 
for the lethal dose of the pure acid in man (probably about .06 to .09 
gm. (1 to i l / 2 gr.)) is much larger than that of some of the poi- 
sonous alkaloids. After large doses in mammals there may be prac- 
tically no symptoms. The animal falls to the ground with a slight 
convulsive movement or a scream, and death results in a few seconds 
from arrest of the respiration and heart. One drop of the pure acid, 
however, when placed inside the eye of even moderately large animals, 
has been known to destroy life instantly. In man the symptoms usually 
commence in a few seconds after taking a large dose of hydrocyanic 
acid. The patient falls insensible, and the eyes will be found fixed, 
glassy, and with dilated pupils, the limbs relaxed, the skin cold and 
clammy, the pulse so small as to be scarcely perceptible, and the res- 
piration slow, deep, and convulsive. Death takes place, as has been 
mentioned, from respiratory failure. When the poisonous quantity 
taken is smaller, there is at first an acrid, burning taste, which is ac- 
companied by increased salivary secretion and followed by numbness 
of the mouth and throat. In the stomach there is a feeling of warmth, 
followed by nausea and vomiting. Other symptoms are headache, con- 
fusion, dyspnoea, slowness of the pulse, and great prostration, while 
the pupils are widely dilated and the eyeballs protrude. Soon uncon- 
sciousness supervenes, with or without convulsions, and then general 
paralysis, with involuntary defecation and micturition. 

Post-mortem. — The characteristic odor of hydrocyanic acid is gen- 
erally perceptible. The body is livid and the blood very dark. The 
heart is soft and flaccid and there is generally considerable congestion 
of the gastric mucous membrane. Post-mortem rigidity sets in very 
early, and the teeth are clinched, the fingers tightly closed, the toes 
strongly flexed, and the eyes prominent and staring. 

Treatment. — In cases of poisoning by hydrocyanic acid the fatal re- 
sult is usually produced so rapidly that the physician rarely has the 

38 



57$ PHARMACOLOGY AND THERAPEUTICS. 

opportunity of interfering. If life is not already extinct, the utmost 
promptitude is called for. The stomach should be washed out imme- 
diately, or vomiting should be induced by inserting the finger into 
the throat. Should this prove ineffectual, large doses of emetics must 
be given, as every moment is precious, and it is found that recovery 
is rapid when it has once set in. Atropine has been proposed as an 
antidote, but there is no reason to suppose that it will prove of ser- 
vice, since it has been shown that it is of no benefit in experiments on 
animals. The real element of danger is the stoppage of the heart, for 
although the respiration fails before this, respiratory paralysis can 
always be more or less successfully counteracted by artificial respiration, 
which is usually called for in poisoning by this drug. General stimu- 
lants, such as brandy or ether, given subcutaneously, are indicated, 
and ammonia, by inhalation, and caffeine may also be of service. Cold 
affusions, or alternately hot and cold, may be of assistance. Cobalt chlo- 
ride, which has proved valuable in a considerable number of instances, is 
believed by some to be the best chemical antagonist. A thirty per cent, 
solution of hydrogen dioxide may be employed to wash out the 
stomach. Intravenous injections of sodium thiosulphate (producing 
theoretically the relatively harmless sulphocyanide) enable animals to 
survive an otherwise lethal dose. The following results of experiments 
recently made in Australia are of great interest and value: i to 100,000 
of potassium cyanide produced in rabbits, within seven minutes, stag- 
gering gait and very rapid respirations, followed shortly by labored 
breathing. Convulsions of varying intensity always occurred, and at 
times appeared within three minutes after introduction of the drug. 
Exhaustion followed the spasms, respiration became shallower and 
shallower, and the animals died. Hydrogen dioxide, when used sub- 
cutaneously, as recommended, in 3 per cent, solution was immediately 
broken up, and its effects were nil. A similar result followed its ad- 
ministration by the stomach, even when the poison and the supposed 
antidote were introduced mixed. While hydrogen dioxide does oxidize 
cyanides, its action was found to be too slow to be of therapeutic value. 
Twenty-six experiments with cobalt chloride pointed to the fact that 
this salt is capable of forming an insoluble cyanide, but that for this 
purpose it must be given in excess. The acid of the gastric juice does 
not interfere with the reaction. Cobalt chloride itself, however, is not 
free from poisonous action, producing severe gastro-enteric symptoms. 
These should be carefully guarded against. Ferrous hydrate, when added 
to a cyanide salt forms a ferrocyanide almost instantaneously. This is 
but slightly poisonous, and its administration would seem to be even 
better than the cobalt, in view of the toxic action of the latter. Un- 



WILD CHERRY. 579 

fortunately, however, the strongly acid contents of the stomach con- 
tents greatly hinder the action of the ferrous hydrate, and hence alkalies 
must be added to neutralize the free hydrochloric acid. Magnesium 
oxide is the best for this purpose. Another drawback is that the ferro- 
cyanides are kept in solution with difficulty. As the result of their 
investigations the experimenters recommend the following treatment : 
Have in readiness in places where cases of cyanide poisoning are likely 
to occur the following: 30 c.c. (1 fl. oz.) of a 23 per cent, solution of 
ferrous sulphate; 30 c.c. ( 1 fl. oz.) of a 5 per cent, solution of caustic 
potash; 1.80 gm. (30 gr.) of powdered magnesium oxide; a metal re- 
ceptacle of 500 c.c. (1 pint) capacity; a stomach-tube. The first two 
solutions should be kept in air-tight tubes, which can be broken into 
the receptacle. When a case of poisoning occurs this is to be done, 
the powdered magnesia and 250 c.c. (^ pint) of water added, and the 
mixture shaken up and administered. This amount of antidote, it is 
stated, will take care of 6.50 gm. (75 gr.) of potassium cyanide. As 
cyanide poisoning has become not infrequent among the Australian 
miners since the introduction of the cyanides in the extraction of gold, 
it is advised that the antidote be kept in all mines where such processes 
are employed, in readiness for instant use, since time is the most im- 
portant factor in securing a successful result. 

WILD CHERRY. 
PRUNUS VIRGINIANA.— Wild Cherry. Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Pruni Virginianse. — Fluidextract of Wild 
Cherry. Dose, 2 C.C.; 30 Tl\.- 

2. Infusum Pruni Virginianse. — Infusion of Wild Cherry. 
Dose, 60 c.c.; 2 fl. oz. 

3. Syrupus Pruni Virginianse. — Syrup of Wild Cherry. Dose, 
4 c.c.; 1 fl. dr. 

Action of Wild Cherry. 
Wild cherry is an aromatic bitter tonic. As hydrocyanic 
acid is yielded when it is treated with water, its preparations 
possess more or less of the sedative action of that agent, and 
very large doses have a depressing influence upon the heart. 
In common with the apple and some other fruit trees, the root- 
bark contains a glucoside, phloridzin, which has the effect of 



58O PHARMACOLOGY AND THERAPEUTICS. 

producing glycosuria. This differs from the glycosuria met 
with in the disease diabetes mellitus in that the sugar of the 
blood is not augmented. Hence, it has been pointed out, it is 
not attributable to any change in the general metabolism, but 
no doubt to some alteration of the renal epithelium, in conse- 
quence of which the blood sugar escapes into the urine, instead 
of being retained in the system and used as a source of energy. 

Therapeutics of Wild Cherry. 
It is highly esteemed as a stomachic tonic, and the infusion 
is used in atonic dyspepsia and chronic gastric catarrh, as well 
as in convalescence from acute diseases and' other debilitated 
states of the system. The preparations of wild cherry have 
the same effect as hydrocyanic acid in relieving cough, by 
diminishing reflex excitability. The drug is sometimes a use- 
ful palliative in phthisis, where it may serve not only to alle- 
viate the irritative cough, but also as a remedy for cardiac 
palpitation and gastric debility. The syrup is very largely 
employed as an ingredient of cough mixtures in' general. Used 
as a vehicle for tincture of digitalis, it renders the latter less 
likely to produce gastric disturbance. 

CHERRY LAUREL. 

LAUROCERASI FOLIA.— Cherry Laurel Leaves (B. P., not offi- 
cial). 

Unofficial Preparation. 
Aqua Laurocerasi.— Cherry Laurel Water. Dose, 2.0 to 8.00 
c.c; y 2 to 2 fl. dr. 

Action of Cherry Laurel. 
Its action is the same as that of diluted hydrocyanic acid. 

Therapeutics of Cherry Laurel. 
Aqua Laurocerasi, B. P., is made by distillation and stand- 
ardized so that its strength is 0.1 per cent, of absolute hydro- 
cyanic acid ; dose, 2 to 8 c.c.. ; ^ to 2 fl, dr. Owing to evapora- 



APOMORPHINE. 58 1 

tion, it is of very varying strength, and as it cannot therefore 
be depended upon, and the inequality of its effects may possibly 
lead to disastrous results, it is but rarely employed, except it 
may be merely as a flavoring agent. As any virtues which it 
may possess are due entirely to the hydrocyanic acid contained 
in it, it is preferable to use in its stead a definite solution of 
this acid or of oil of bitter almonds. 

C. Drugs Affecting the Bronchial Secretion. 
APOMORPHINE. 

APOMORPHINE HYDROCHLORIDUM.— Apomorphine Hydro- 
chloride. Dose (expectorant), 0.002 gm. (2 milligm.) ; -£ gr.; 
(emetic), 0.005 gm. (5 milligm.); T ^ gr. 

Unofficial Preparation. 
Apocodeina. — Apocodeine. Dose, 15 to 20 gm.; y 4 to y 3 gr., 

hypodermatically. 

Action of Apomorphine Hydrochloride. 

External. — Apomorphine is said to have some anaesthetic 
effects on the cornea when a solution is dropped upon it. 

Internal. G astro -intestinal Tract. — Apomorphine is the 
most powerful emetic known. It is an indirect emetic, because 
its action is on the vomiting centre in the medulla, and not a 
local one on the stomach. This is apparent from the fact that 
vomiting is produced more promptly, and with a smaller dose, 
if the drug is administered hypodermatically than when it is 
given by the mouth. It is shown even more positively by the 
fact that when injected subcutaneously it acts if the blood- 
vessels are ligatured in such a way that none of it can reach 
the stomach, while it does not act if they are so tied that none 
can reach the medulla. Moreover, no emesis is produced if 
apomorphine is placed in the stomach after the vessels supply- 
ing that organ have been ligatured. Still again, if the medulla 
be brushed with apomorphine solution, vomiting follows imme- 
diately. The act of vomiting is preceded by nausea, and it is 



582 PHARMACOLOGY AND THERAPEUTICS. 

found that symptoms of nausea may be elicited by doses of the 
drug too small to give rise to vomiting. Under the ordinary 
hypodermatic dose the latter usually occurs in man inside of 
fifteen minutes. The nausea generally disappears rapidly, but 
occasionally persists for some time and may be accompanied 
by a repetition of the vomiting. Collapse has been known to 
occur, but this is simply a result of the vomiting and not a 
direct effect, and it is not usually dangerous. In frogs no 
emesis is induced by apomorphine. 

Muscles. — Under large amounts the irritability of striped 
muscle is much diminished and finally abolished in frogs, but 
no such action has been observed in mammals. This weaken- 
ing in the contraction of the muscles is quite distinct from the 
feeling of weakness accompanying nausea in man. In frogs 
a similar action has been demonstrated on the cardiac muscle; 
the heart being stopped even after atropine. 

Heart and Circulation. — During the act of vomiting there is 
an increase of pulse and of blood-pressure. The acceleration 
of the pulse, however, as well as the feeling of depression and 
muscular weakness present, is simply a result of the emetic 
action. Although in a few instances alarming collapse has been 
observed, no actual fatality is stated to have occurred from 
the use of the drug. 

Respiration. — There is an increase of respiration in conse- 
quence of the vomiting. If the amount of the drug is suffi- 
ciently large, its irritant effects are produced upon the rest of 
the central nervous system, as well as the vomiting centre, and 
in consequence of this action also the respiration is quickened. 
Physiological experiments show that apomorphine produces a 
watery discharge from the blood-vessels of the respiratory 
mucous membrane, which is found to be paler after the admin- 
istration of this remedy, as well as less cedematous. This 
effect is produced within a half hour after ingestion, and it is 
not in any respect the first stages of emesis. Large doses 
eventually depress the respiration. 

Nervous System. — Its action on the central nervous system 



APOMORPHINE. 583 

is shown first and mainly upon the vomiting centre, so that the 
only direct effect of small doses is the production of the symp- 
toms of emesis. If the drug is administered in large quantities, 
and especially to animals incapable of vomiting, like the herbi- 
vora, its irritant effects upon the rest of the central nervous 
system are seen in the production of marked restlessness, with 
circus movements, excitement and terror. The movements 
then become less coordinated, and eventually tetanic convul- 
sions set in. During the convulsions the respiration, which 
was at first greatly accelerated, ceases, while the heart con- 
tinues to beat for some time later. In man minute doses are 
said to be slightly hypnotic. 

Fate in the Body. — Apomorphine is not excreted into the 
stomach, like morphine, and it is stated that it has not been 
found in the mucous membranes of the air passages. It is 
possible that it may be decomposed in the tissues. 

Therapeutics of Apomorphine Hydrochloride. 

Vomiting Action. — The advantages of apomorphine over 
other emetics are that it is certain, prompt and energetic, that 
it can be given when emetics exhibited by the stomach would 
not act, and that it produces no gastric irritation. It is hence 
particularly valuable in cases of poisoning. It is usually ad- 
ministered subcutaneously, dissolved in camphor water; 1 in 
50. Dose, .25 to .50 c.c. (4 to 8 ^l). This must be prepared 
extemporaneously, as it will not keep. 

Expectorant Action. — It is, when given by the mouth, a valu- 
able expectorant. In an adult .002 gm. (/* gr.), or 4 c.c. (1 
dr.) of the syrup (see below) will produce a watery expectora- 
tion within the time above stated, and this effect will last from 
two to three hours. It is particularly useful in the early stages 
of acute bronchitis, in chronic dry bronchitis, in chronic ca- 
tarrhal pneumonia, and in old tuberculous patients who are 
harassed by an unproductive cough. 

Soporific Action. — Recently it has been claimed that when 
given hypodermatically at bedtime, in dose just short of pro- 



584 PHARMACOLOGY AND THERAPEUTICS. 

during emesis, sleep, closely approaching the normal, ensues. 
This is not always the case, and its hypnotic action may be 
due to contamination with other alkaloids. 

The British Pharmaceutical Conference recommends the fol- 
lowing Syrup of Apomorphine: Mix Rectified Spirit, 84; with 
the same amount of water; dissolve in this Apomorphine Hy- 
drochloride, 1 ; add Diluted Hydrochloric Acid, 24 ; and finally 
Syrup, 1728 parts. Dose, 2 to 4 c.c. (/ 2 to 1 fl. dr.). The 
drug may also be given as a lozenge. 

Apocodeine is formed from codeine in the same way as apo- 
morphine from morphine. According to some observers, it 
has, when injected subcutaneously, the same action as apomor- 
phine, while others state that pure apocodeine is not an emetic, 
but a cerebral depressant. It induces free secretion of saliva, 
and is used chiefly as an expectorant, particularly in chronic 
bronchial affections. 

COCILLANA. 
Unofficial Preparation. 
Cocillana.— Cocillana. Dose, .30 to 1.20 m.; 5 to 20 gr. 

Action of Cocillana. 
Cocillana acts upon muciparous glands, increasing their ac- 
tivity; on the bronchial mucous membrane, causing expectora- 
tion; on the intestinal mucous membrane, producing a laxative 
effect; it also slightly increases the appetite; it slightly 
strengthens the heart beat and the pulse, but does not stimulate 
the respiratory centre. The syrup does not act as a laxative, 
while the resins are distinctly purgative. 

Therapeutics of Cocillana. 
Cocillana is of very great value as an expectorant, preferable 
to ipecacuanha, in that it does not so readily cause nausea and 
a metallic taste in the mouth, while it assists the regular move- 
ment of the bowels. If, however, nausea should be produced, 
this is very persistent. Its action is fully established in from 
three to six hours after administration, and persists at least for 



IPECACUANHA. 585 

six hours. It can, in many cases, be substituted for apomor- 
phine, ammonium carbonate, and many other drugs, classed, 
with more or less reason, as expectorants. 

IPECACUANHA. 

IPECACUANHA. — Ipecac. Dose (expectorant), 0.065 gm. (65 
milligm.) ; 1 gr.; (emetic), 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Ipecacuanha. — Fluidextract of Ipecac. 
Dose (emetic), 1 C.C.; 15 TTL ; (expectorant), 0.05 C.C.; 1 TTL- 

2. Syrupus Ipecacuanha. — Syrup of Ipecac. Dose (expec- 
torant), 1 c.c; 15 ul; (emetic), 15 c.c; 4 fl. dr. 

3. Vinum Ipecacuanhae. — Wine of Ipecac. Dose, 1 c.c; 15 TTL. 

4. Pulvis Ipecacuanha et Opii. — Powder of Ipecac and 
Opium. (Dover's Powder.) Dose, 0.500 gm. (500 milligm.) ; 
7V 2 gr. 

5. Tinctura Ipecacuanha et Opii. — Tincture of Ipecac and 
Opium. Dose, 0.5 c.c.; 8 n\. 

6. Pilula Laxativa Composita. — Compound Laxative Pills. 
Dose, 2 pills. 

Unofficial Preparations. 
Trochisci Ipecacuanha (U. S. P., 1890). — Troches of Ipecac. 
Trochisci Morphina et Ipecacuanha (U. S. P., 1890). — 
Troches of Morphine and Ipecac. 

Action of Ipecacuanha. 

External. — Ipecacuanha powder is a powerful irritant to the 
skin, producing redness, vesication, and even pustulation and 
ulceration, when its application is prolonged. It is also irritant, 
naturally, to mucous membranes, and some individuals are so 
susceptible to its local action that the opening of a jar of the 
drug at a distance of several feet will produce violent sneezing, 
irritation of the eyes, coughing, and other unpleasant symptoms. 
It possesses some antiseptic properties, being capable of de- 
stroying the bacilli of anthrax, though having no offect on the 
spores. 

Internal. Alimentary Canal. — When taken by the mouth its 



586 PHARMACOLOGY AND THERAPEUTICS. 

irritant effect is exerted on the mucous membrane of the ali- 
mentary canal, and in small doses it is a stomachic; producing 
moderate gastric hyperemia and an increased flow of saliva 
and gastric juice, and thus aiding digestion. In large doses it 
is a powerful emetic. It is still an unsettled question whether 
this action is due entirely to the local effect of the emetine on 
the stomach, or in part to this and partly to its influence on the 
vomiting centre in the medulla. Most of the reliable evidence 
at command, however, points to a peripheral gastric, and not 
to a central, action. Unlike apomorphine, which is known to 
act directly on the centre, ipecacuanha causes vomiting as 
quickly and with as small doses when it is given by the mouth 
as when administered hypodermatically ; and the fact that 
emetine, like many other irritants, has a specific action on the 
alimentary canal when injected subcutaneously would seem 
to satisfactorily explain the emetic action of the drug when 
given by this method. A certain amount of depression is pro- 
duced by ipecac, but this is simply a result of the vomiting. If 
the dose is sufficiently large, and the most of it is not ejected 
in the emesis caused, the irritant effect of the drug is continued 
in the intestine, with the production of increased secretion and 
purging. It also has a cholagogue action, directly augmenting 
the biliary secretion. When injected subcutaneously in animals, 
emetine induces nausea, vomiting and catharsis, frequently with 
bloody stools, followed by collapse and generally by death 
from exhaustion in the course of a few hours. When vomiting 
is not produced by large doses given in this manner collapse 
still results, and after some weak convulsive movements, the 
animal dies of cardiac failure. When the fatal result does not 
occur for from eighteen to twenty-four hours, evidences of 
gastro-enteritis are often found after death. 

Circulation and Nervous System. — When emetine is injected 
intravenously the cardiac effects are more pronounced than 
when it is given by the mouth or hypodermatically. After 
large amounts the central nervous system is acted upon. Para- 
lytic symptoms are developed, and among the earliest in mam- 



IPECACUANHA. 587 

mals is vaso-motor paralysis with fall of blood-pressure. Con- 
tributory to the production of the fall is weakening of the 
heart's action from the direct effect of the drug upon the 
cardiac muscle, and this results in death. In the frog, in 
which no vomiting is caused, a slowly advancing central 
paralysis is observed, and the heart's movements grow weak 
and irregular, and finally cease from paralysis of the cardiac 
muscle. 

Respiration. — The respiratory movements are but little 
affected by moderate doses of ipecac, though as the result of 
the vomiting they may be somewhat quickened. The inhala- 
tion of the powder causes congestion of the bronchial mucous 
membrane, with increased secretion, and excites cough by re- 
flex stimulation; and the same effect is produced by the ex- 
cretion by this membrane of the drug when it is taken inter- 
nally. Animals poisoned by large doses of emetine present 
after death more or less hyperemia of the bronchial mucous 
membrane and of the lungs, and in some instances, especially 
among rabbits, pulmonary oedema is found. 

Skin. — Ipecac is in part excreted by the skin, and it acts as 
a mild diaphoretic. The cutaneous action resembles that pro- 
duced by the application of warmth. 

Therapeutics of Ipecacuanha. 

External. — Ipecacuanha has been used with success, as an 
antiseptic, in cases of anthrax. In the dermatitis caused by 
rhus toxicodendron a lotion containing powdered ipecac, 12 gm. 
(3 dr.) to 500 c.c. (1 pint) of water, has been recommended, 
and for the bites of insects, especially mosquitoes, one com- 
posed of 2 gm. (y 2 dr.) and 15 c.c. { l / 2 fl. oz.) each of alcohol 
and ether. 

Internal. Alimentary Tract. — Ipecac is quite generally em- 
ployed as an emetic. It is contra-indicated in the very feeble, 
as it has no property that will serve to mitigate the depressing 
effects of the vomiting; nor on account of the slowness of 
its action, should it be used in cases where, as in poisoning, 



588 PHARMACOLOGY AND THERAPEUTICS. 

a prompt evacuation of the stomach is called for. Its chief 
use as an emetic is for clearing the passages in diseases of the 
respiratory organs, and in infants and young children, par- 
ticularly, who cannot cough well, it often acts very happily. 
In the domestic treatment of laryngismus stridulus an emetic 
dose of the syrup is the most usual remedy. Ipecacuanha is 
also of service as an emetic when the stomach is to be relieved 
of undigested food, and attacks of acute indigestion, migraine, 
and the so-called bilious headache may sometimes be cut short 
by the vomiting caused by it. An ipecac emetic was formerly 
administered to a considerable extent at the beginning of con- 
tinued fevers, the eruptive fevers, erysipelas, and malarial 
fever, and some clinicians still advocate this method of treat- 
ment in suitable cases, claiming that experience has shown the 
good effects of the practice on the subsequent course of the 
disease. The indications for its use in cases of this kind are 
considered by them to be : a heavily coated tongue, much nausea 
with ineffectual efforts to vomit, marked epigastric oppression, 
icterus or an icterode hue of the surface, a hot and dry skin, 
acid and turbid urine. For emetic purposes a small dose (.03 
gm. to y 2 gr.) of tartar emetic is sometimes combined with it. 
In small doses, such as .25 to .30 c.c. (4 or 5 1U) of the wine 
or .015 gm. (J4 gr.) of the powder, ipecac is sometimes used 
as a stomachic, and, employed in this way, it may even serve 
to check vomiting. It has been known to arrest obstinate 
attacks of vomiting which had resisted all other treatment, and 
one of the recognized methods of controlling the vomiting of 
pregnancy is the administration of .06 to .12 c.c. (1 or 2 ""l) 
of the wine in water every half hour. .03 gm. {]/ 2 gr.), or 
more, of ipecacuanha, combined with other cholagogues, has 
been found useful in cases of dyspepsia in which there is 
functional derangement of the liver, and in gastric ulcer 
Dover's powder {see p. 590) is sometimes beneficial. One of 
the most important applications of the drug is in the treatment 
of dysentery. Epidemic dysentery, especially of malarious 
and tropical countries, is the form of the disease to which it 



IPECACUANHA. 589 

seems best adapted, but it may often be used with advantage 
in other varieties also. In the severe attacks of tropical regions 
from 1.20 to 4.00 gm. (20 to 60 gr.) are usually given for the 
initial dose and about 1.20 gm. (20 gr.) every four., six or eight 
hours afterward. It is considered important to establish toler- 
ance of the remedy as soon as possible, and subsequent doses 
may be retained if the first one is rejected. In order to secure 
the retention of these large doses it may be combined with 
opium and aromatic powder, or other expedients may be re- 
sorted to. Milk is a good vehicle for the administration of 
ipecacuanha, and in acute dysentery doses of 1 gm. (15 gr.), 
given in milk, are generally fairly well borne. Some authori- 
ties advise doses of 2 gm. (30 gr.), without any liquid, at the 
onset, the ipecac to be preceded by a sedative dose of opium. 
The good effects of the remedy have been attributed by some 
to the large amount of tannic acid contained in the root, and 
as emetine and cephaeline are much more irritant to the in- 
testine than the unaltered drug, a preparation from which 
the alkaloids have been removed (Ipecacuanha Deemeti- 
nisata, dose .60 to 2.00 gm. ; 10 to 30 gr.) has been used 
with advantage, it is claimed, in this disease. On the other 
hand, it has been stated that the efficient agent in the treat- 
ment of dysentery is the emetine, and those holding this view 
deny that the same results are obtained by the use of this 
preparation. The deemetinized ipecac is said to have the ad- 
vantage of not causing any nausea or vomiting, and if the 
claims of its advocates should prove to be well founded, it 
would undoubtedly be much preferable on this account. In 
chronic dysentery ipecac is by no means so distinctly efficient 
as in acute, but in association with other remedies is often 
very useful. In catarrhal jaundice and in diarrhoea, especially 
when associated with hepatic derangement, it is sometimes of 
service. In bowel affections it is often combined with opium 
and mercury. It is useful also in the summer complaint of 
infants and young children when the stools are of a greenish 
color and contain mucus or blood. With it may be associated 
bismuth, pepsin, zinc oxide or other remedies, as indicated. 



590 PHARMACOLOGY AND THERAPEUTICS. 

Respiratory Tract. — It is in very general use as an expec- 
torant in the form of the syrup, the wine, and ipecac troches. 
It not only increases the secretion of the bronchial mucous 
membrane, but also has the effect of rendering it more fluid 
and therefore less tenacious; while its property of exciting the 
act of coughing often adds to its usefulness. The fluidextract 
is considered the most efficient preparation by some practition- 
ers. The wine, more or less diluted, in the form of a spray 
from a hand atomizer, has sometimes been found of service in 
winter cough, chronic bronchitis, emphysema and fibroid phthi- 
sis, in allaying the spasmodic vomiting and liquefying the secre- 
tions. In children, too, the wine, in doses of from .30 to .60 
c.c. (5 to 10 TTL), is apt to be especially beneficial in the chronic 
bronchitis which remains after whooping-cough, measles or 
influenza, or is associated with chronic tonsillo-pharyngitis or 
adenoids. A general tonic treatment should also be maintained 
at the same time. In the treatment of acute bronchitis ipe- 
cac is usually much more valuable in children than in the case 
of adults. Cephaelin seems to possess the expectorant proper- 
ties of ipecacuanha. 

As a Diaphoretic. — Dover's powder is an excellent anodyne 
diaphoretic, and is frequently given, in doses of .60 gm. (10 
gr.) in chills and in the early stage of catarrh of the respira- 
tory passages and of mild feverish attacks in general. In the 
intense suffering which sometimes results from the sudden sup- 
pression of menstruation it is often of great service in reliev- 
ing pain and promoting diaphoresis. In acute rheumatism and 
other diseases where also it is desired to allay pain and at the 
same time increase the action of the skin, this powder may be 
administered in doses of from .18 to .30 gm. (3 to 5 gr.) every 
two, three or four hours, according to circumstances. 

As a Hemostatic. — Ipecacuanha has long been regarded as 
an internal haemostatic, and it has been employed especially in 
haemoptysis, haematemesis and uterine haemorrhage. At the 
present time, however, it is much less frequently used as an 
anti-haemorrhagic remedy than formerly. In haemoptysis small 



SENEGA. 59I 

doses, short of producing vomiting, it is stated, serve to reduce 
the bleeding by decreasing the pulmonary congestion. Some 
writers, on the other hand, advise that in haemorrhages the 
drug should be given in frequently repeated doses until vomit- 
ing ensues, maintaining that when this effect is produced the 
haemorrhage usually ceases. 

On account of their irritant properties, neither the prepara- 
tions of ipecac nor its alkaloids are suitable for subcutaneous 
injection. 

SENEGA. 

SENEGA. — Senega. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Senegae. — Fluidextract of Senega. Dose, 
1 c.c; 15 ttl. 

2. Syrupus Senegae.— Syrup of Senega. Dose, 4 c.c; 1 fl. dr. 

3. Syrupus Scillae Compositus. — Compound Syrup of Squill. 
Dose, 2 c.c; 30 Ttl. 

Action of Senega. 

External. — Senega is irritant to the skin when applied re- 
peatedly or rubbed on in the form of ointment, and has a very 
marked irritant action on mucous membranes. When the pow- 
dered root is inhaled it causes hyperaemia and increased secre- 
tion in the respiratory passages, and excites violent sneezing 
and coughing. 

Internal. Alimentary Canal. — When swallowed, its irritant 
effect on the mucous membrane induces increased secretion of 
saliva and gastric juice. In large doses it causes not only 
salivation, but more or less marked inflammation of the gastro- 
intestinal tract, with nausea, vomiting and purging. 

Respiration. — Senega is a stimulating expectorant. When 
the drug is taken internally, senegin is excreted through the 
bronchial mucous membrane, with the result of producing vas- 
cular dilatation and augmented secretion and of reflexly excit- 
ing cough. It is on the respiratory passages that it appears 
to exert its-most important influence. 



592 PHARMACOLOGY AND THERAPEUTICS. 

Blood and Circulation. — When added to defibrinated blood, 
senegin is found to dissolve the red corpuscles and liberate the 
haemoglobin and the salts. Even when it is injected into the 
blood of living animals this action is observed to some extent, 
the plasma containing haemoglobin, while the corpuscles are 
considerably diminished in number. In mammals the circula- 
tion appears to be comparatively little affected until shortly 
before death, when there is a rapid fall of blood-pressure and 
the pulse becomes feeble and slow. For a short time after the 
respiration fails the heart continues to beat, but its movements 
are extremely weak, and it finally stops in diastole, even if arti- 
ficial respiration is maintained. 

Nervous System and Muscles. — When senegin is injected 
into the blood in moderate toxic quantities, the symptoms usu- 
ally produced are principally intestinal, and fatal collapse from 
the changes in the alimentary canal occurs after the elapse of 
several days ; but when large doses are used the central nervous 
system is most affected. At first there are violent convulsions, 
then paralysis, especially of the respiratory centre, and the 
fatal result is very rapid. If the poison is applied directly to 
skeletal or cardiac muscle or to nerve trunks, they lose their 
irritability at once, and even in dilute solutions muscle con- 
tracts more weakly, and eventually is not only paralyzed but 
structurally altered. 

Kidneys. — Senegin is absorbed with difficulty, and is ex- 
creted by the kidney, as well as the bronchial mucous mem- 
brane, and also to some extent, it is said, by the skin. In the 
process of excretion it irritates the renal epithelium, and the 
drug therefore has diuretic properties. 

Therapeutics of Senega. 
Senega is used now only- as a stimulating expectorant. In 
subacute and chronic bronchitis it may prove useful in excit- 
ing an increased secretion of mucus and facilitating its expul- 
sion from the respiratory passages. It should not be given in 
acute conditions on account of its irritant effect on mucous 



QUILLAJA. 593 

membranes, and for the same reason it is contra-indicated 
whenever gastric irritability or intestinal disorder is present. 
It is commonly prescribed in combination with other drugs in 
expectorant mixtures. 

QUILLAJA. 
QUILLAJA. — Quillaja. (Panama Bark. Soap Bark.) 

Preparations. 
Fluidextractum Quillajse. — Fluidextract of Quillaja. Dose, 
0.2 c.c; 3 m,. 

Tinctura Quillajae. — Tincture of Quillaja. 

Unofficial Preparation. 
Infusum Quillajae. — Infusion of Quillaja. Dose, 8 to 30 c.c; 
2 to 8 fl. dr. 

Action of Quillaja. 

Quillaja is allied to senega in its properties, but is a much 
more powerful irritant, as the principle quillaja-sapotoxin is 
stated to be about ten times more poisonous than senegin. 

Therapeutics of Quillaja. 
On account of its soapy nature, it may be used to aid the 
diffusion of oils and other soluble bodies, but the fact that it 
contains such a toxic substance as saponin renders it objec- 
tionable for emulsifying medicines for internal use. It is em- 
ployed chiefly as an ingredient of hair lotions, and hairdressers, 
for shampooing, use an aqueous decoction (i to 20), which 
makes an excellent lather. An infusion, employed by means 
of a roller-bandage saturated with it, makes a good stimulant 
application for old ulcers and chronic eczema, and this prepara- 
tion is also useful for hyperidrosis and bromidrosis. In chronic 
eczema and alopecia circumscripta the tincture, used locally, 
may prove of service, and for certain forms of acne the fluid- 
extract, mixed with glycerin, has been recommended. The tinc- 
ture has been given occasionally as an expectorant, and it is 
stated to have proved efficient, especially in cases requiring the 
free expectoration of mucus which was accumulating in the 
39 



594 PHARMACOLOGY AND THERAPEUTICS. 

chest. On account of its irritant qualities, however, it should 
always be employed with caution. 

TEREBENE. 
TEREBENUM.— Terebene. Dose, 0.5 c.c; 8 TTL. 

Action of Terebene. 

Its odor is more pleasant, but in other respects it for the 
most part closely resembles oil of turpentine. Like turpentine 
and many other volatile oils, it causes irritation of the lungs 
in the course of excretion, and therefore increases the bron- 
chial secretion. It is likewise diuretic from the irritation of 
the kidneys excited in the process of excretion, and by its anti- 
septic properties it disinfects both the renal and bronchial 
secretions. 

Therapeutics of Terebene. 

Externally it has been used successfully as a general anti- 
septic dressing for wounds, ulcers, burns, etc. It has also been 
employed with advantage as a substitute for copaiba and other 
similar drugs in the treatment of genito-urinary diseases. In 
fermentative dyspepsia it is useful as an antiseptic. Its most 
important use is as a stimulating disinfectant expectorant, and 
it is highly esteemed in chronic bronchitis, emphysema, winter 
cough, and even phthisis. Although it is said to form an in- 
soluble compound with sugar, it seems to be efficient when 
given on a lump of sugar, which is quite a common method 
of administering it. A few drops taken in this way several 
times a day will not infrequently cure a slight winter cough. 
It may also be given in capsules, in an emulsion, or in a mix- 
ture with other expectorants. It is sometimes employed as an 
inhalation, in some such way as the following: Pure terebene, 
2; magnesium carbonate, i; distilled water, 24; to be used in 
water (1 to 128) at a temperature of 6o° C. (140 F.) in an 
apparatus so arranged that air can be drawn through it and 
inhaled. 



storax. 595 

TERPIN HYDRATE. 
TERPINI HYDRAS.— Terpin Hydrate. Dose, 0.125 gm. (125 
milligm.); 2 gr. 

Action of Terpin Hydrate. 
Terpin hydrate is an antiseptic, and it is stated that it will 
arrest the development of tubercle bacilli. It increases the 
secretion of the mucous membrane, and the functional activity 
of the kidneys. 

Therapeutics of Terpin Hydrate. 
It has been given as an antiseptic in acute and chronic bron- 
chitis, when the secretion is unusually free, in whooping-cough, 
and rarely in the treatment of chronic nephritis, chronic cys- 
titis and gonorrhoea. 

BALSAM OF TOLU. 
BALSAMUM TOLUTANUM.— Balsam of Tolu. Dose, 1 gm.; 
15 gr. 

Preparations. 

1. Syrupus Tolutanus. — Syrup of Tolu. Dose, 16 c.c; 4 
fl. dr. 

2. Tinctura Tolutana. — Tincture of Tolu. Dose, 2 c.c; 30 Til . 

Action of Balsam of Tolu. 
In action, as well as in composition, though it contains more 
benzoic acid, it resembles the balsam of Peru. 

Therapeutics of Balsam of Tolu. 
It is used only as an expectorant and, on account of its 
grateful taste, to flavor medicines, particularly cough mixtures. 
The syrup is almost always prescribed. 

STORAX. 
STYRAX. — Storax. Dose, 1 gm.; 15 gr. 

Unofficial Preparation. 
Styronum. — Styrone. 

Action of Storax. 
Its action is the same as that of the balsams of Tolu and 
Peru and of benzoin, and also resembles that of copaiba. 



596 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Storax. 

Storax is a serviceable application to stimulate and disinfect 
ulcers. Mixed with an equal part of olive oil, it is used in 
some diseases of the skin requiring slight stimulation, and also 
as a parasiticide in scabies and pediculosis. In the form of an 
ointment it is recommended for the ulcerations of frost-bite. 
Internally it has been employed to some extent in the treat- 
ment of gonorrhoea, gleet and catarrhal affections of the genito- 
urinary organs. At present its principal internal use is as an 
expectorant in the compound tincture of benzoin. 

Styrone, a derivative of styracin (chemically, cinnamic or 
cinnamylic alcohol), in a solution of 1 to 12 is said to make 
an excellent antiseptic dressing. It is a prompt deodorizer of 
foul wounds or ulcers, and, being non-poisonous, it may be 
injected into cavities, as after the operation of empyema. It 
may also be used in a spray for affections of the respiratory 
passages. 

SANGUINARIA. 

SANGUINARIA. — Sanguinaria. (Bloodroot.) Dose, 0.125 gm. 
(125 milligm.) ; 2 gr. 

Preparations. 

1. Fluidextractum Sanguinariae. — Fluidextract of Sangui- 
naria. Dose, 0.1 c.c.; iy 2 1T\,. 

2. Tinctura Sanguinariae. — Tincture of Sanguinaria. Dose, 1 
c.c; 15 HI. 

Action of Sanguinaria. 

Sanguinaria is an acrid emetic with stimulant, and in large 
doses, narcotic powers; it is also expectorant and said to be 
an emmenagogue. 

Therapeutics of Sanguinaria. 
It is chiefly used as a stimulating expectorant in chronic 
bronchitis or in advanced stages of the acute disease. 

PLEURISY ROOT. 

Unofficial Preparation. 
Asclepias. — Asclepias (U. S. P., 1890). (Pleurisy Root.) 
Dose, 2.0 to 8.0 gm.; y 2 to 2 dr. 



creosote. 597 

Unofficial Preparation. 
Extractum Asclepiadis Fluidum (U. S. P., 1890). Fluid- 
extract of Asclepias. Dose, 2.0 to 8.0 c.c; y 2 to 2 fl. dr. 

Action of Pleurisy Root. 
Pleurisy root possesses diaphoretic, carminative, and expec- 
torant properties, without being stimulant. 

Therapeutics of Pleurisy Root. 
It is used in the disease which gives its name, and in various 
pectoral affections. 

CREOSOTE. 

CREOSOTUM.— Creosote. Dose, 0.2 c.c; 3 TTt- 

Preparation. 
Aqua Creosoti. — Creosote Water. Dose, 8 c.c; 2 fl. dr. 

Unofficial Preparation. 
Creosoti Carbonas. — Creosote Carbonate. (Creosotal.) Dose, 
1 to 4 c.c; 15 to 60 Til. 

Action of Creosote. 
The action of creosote, externally and internally, is prac- 
tically the same as that of phenol. 

Therapeutics of Creosote. 
Before the introduction of carbolic acid it was employed ex- 
ternally as a mild anaesthetic and a parasiticide, as well as a 
stimulating antiseptic, and internally to relieve vomiting and 
flatulence. It is really superior to phenol as an antipruritic, 
but is not much used on account of its acrid and penetrat- 
ing odor. When applied on cotton to the cavity, it is effi- 
cient in relieving the aching of a carious tooth, and in the 
form of creosote water is valuable as a haemostatic. The most 
important use of creosote is as a pulmonary antiseptic, ad- 
ministered by the mouth, hypodermatically, or by inhalation. 



598 PHARMACOLOGY AND THERAPEUTICS. 

In cases of tuberculosis it can be administered in the form of 
an emulsion with cod-liver oil and acacia ; or with the hypophos- 
phites and cod-liver oil; or with the syrup of wild cherry and 
acacia (.12 c.c. of creosote to 4 c.c. (1 fl. dr.) of emulsion in 
each case), or in a mixture of glycerin and whiskey. The dose 
of creosote should be .03 to .12 c.c. (y 2 to 2 HI), given thrice 
daily, and increased to 1.20 to 1.50 c.c. (20 to 25 ti\) in the 
twenty-four hours, by easy stages. Administered in the form of 
enteric pills (which will dissolve only in the intestinal fluids), 
a daily dosage of 3 to 3.30 c.c. (45 to 50 ^l) can be reached 
without inconvenience. This method is preferable to that 
of Sommerbrodt, which consists in the administration of .06 c.c. 
(1 ^l) of creosote in 12 c.c. (2ITI) of cod-liver oil, in capsules. 
The method of hypodermatic injection in sterilized olive oil 
requires a special apparatus, is very tedious, somewhat painful, 
and altogether irksome to patient and physician. By inhala- 
tion creosote is employed with equal parts of alcohol and spirit 
of chloroform, or in alcohol, one part to eight, in a perforated 
zinc inhaler, of which 1 c.c. (15 ^l) is placed upon a bit of 
cotton and used for fifteen minutes in every hour. If the best 
beechwood creosote is employed, no untoward results are likely 
to be obtained. If the dose is increased too rapidly there may 
occur some nausea, epigastric uneasiness, and even vomiting. 
Disturbance of the kidneys has been produced, and the urine 
then presents practically the same appearances as after the 
ingestion of phenol {see p. 61). The stomach symptoms have 
been relieved by the patient's placing himself upon his back, 
for half an hour after administration of the remedy. It is 
quite likely that the patient acquires a tolerance, for the daily 
dose of 20 c.c. (300 Til) has been given for a considerable time, 
with benefit, although 3.30 c.c. (50 1U) should be considered as 
the maximum daily dose. Creosote is more efficient than either 
of its principal constituents, guaiacol or creosol, even if given 
in proportionate dose. Creosote should never be given to the 
aged. 

Creosote carbonate (not official), which contains 92 per cent. 



QUAIACOL. 599 

of creosote, does not possess the caustic and irritative proper- 
ties of the pure creosote, and can be administered in dose of 
from i to 4 c.c. (15 to 60 ^l) in a wineglass of sherry after 
meals. As it is slowly absorbed, it is probable that it is elimi- 
nated for the most part by the bronchial mucous membrane. 
Since it does not irritate the gastro-intestinal tract nor the kid- 
neys, it is the method of choice in the treatment of pulmonary 
tuberculosis. Creosote carbonate is also highly esteemed in the 
treatment of pneumonia, and under its use, as in the case of 
sodium salicylate, defervescence is much more frequently by 
lysis than by crisis, which is ordinarily the rule in this disease. 

GUAIACOL. 

GUAIACOL. — Guaiacol. (Methyl Pyrocatechin.) Dose, 0.5 C.C.; 
8 Til . 

Preparation. 
Guaiacolis Carbonas. — Guaiacol Carbonate. Dose, 1 gm.; 
15 gr. 

Unofficial Preparations. 
Guaicolis Benzoas. — Guaiacol Benzoate. (Benzosol. Benzoyl 
Guaiacol.) Dose, 0.10 to 0.60 gm.; 2 to 10 gr. 

Guaiacolis Salicylas. — Guaiacol Salicylate. Dose, 0.30 to 
2.00 gm.; 5 to 30 gr. 

Action of Guaiacol. 
Guaiacol is locally an antiseptic and its general action is 
similar to that of creosote, but it is less likely to irritate the 
intestinal canal and kidneys. 

Therapeutics of Guaiacol. 

External. — If painted on the skin over an area of from 10 
to 50 sq. cm. (4 to 20 square inches), it is capable of reducing 
pyrexia, but it is not used for this purpose on account of the 
sweating and collapse which it occasions. 

Internal. — Benzosol was introduced as a nearly tasteless com- 
bination for the administration of guaiacol. In the digestive 
tract it splits up into guaiacol and benzoic acid. As an in- 



600 PHARMACOLOGY AND THERAPEUTICS. 

testinal disinfectant it has proved to be of service in the treat- 
ment of diabetes mellitus. The carbonate and salicylate have 
been used as substitutes for guaiacol, and are in many cases 
preferable to it. Guaiacol, especially the carbonate, has been 
used to a large extent in pulmonary tuberculosis, under the 
idea that it has a destructive effect upon the bacilli of the 
disease; but there is no absolutely certain evidence that such 
is the case. The carbonate has given excellent results in the 
treatment of typhoid fever in limiting the decomposition in 
the intestines. 

INULA. 

Unofficial Preparation. 
Inula. — Inula (U. S. P., 1890). (Elecampane.) Dose, 1 to 
4 gm.; y 4 to 1 fl. dr. 

Unofficial Preparation. 
Heleninum.— Helenin. Dose, .02 to .12 gm.; y 3 to 2 gr. 

Action of Inula. 
Inula is demulcent, tonic and gently stimulant. 

Therapeutics of Inula. 
It is chiefly used in diseases of the lungs, especially when 
the affection is associated with general debility. Recently, some 
laboratory experiments have suggested that helenin (its active 
principle) may be of value in the treatment of tuberculosis, 
since it is believed to be a bactericide. 

D. Antispasmodics. 

GRINDELIA. 
GRINDELIA.— Grindelia. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Grindelise. — Fluidextract of Grindelia. Dose, 
2 c.c; 30 TTL- 



GRINDELIA. 6oi 

Action of Grindelia. 
By reason of its volatile oil, grindelia is gently stimulating 
to the stomach. In therapeutic doses it appears to have little 
or no action on the heart or arteries, but in large quantities it 
slows the heart by stimulating the vagi and raises blood- 
pressure by stimulating the vaso-motor centre. In these large 
doses it may also induce paralysis of the peripheral sensory 
nerves, the sensory centres in the spinal cord, and, finally, the 
motor centres and nerve-trunks. It is excreted by the bron- 
chial mucous membrane, as well as by the kidneys, and at first 
slightly increases the secretion of mucus, but afterward dimin- 
ishes it. It appears to have a special action in relaxing the 
muscular coats of the bronchi, and this is said to be through 
depression of the ends of the- motor fibres of the vagus dis- 
tributed to the parts and of the reflex centre in the medulla 
oblongata. The terminations of the sensory nerves supplying 
the bronchial mucous membrane are also said to be depressed. 
In the course of its elimination by the kidneys it excites more 
or less renal irritation, with increased urinary secretion. 

Therapeutics of Grindelia. 
In ivy poisoning rapid relief is often afforded by the appli- 
cation of cloths dipped in a mixture of the fluidextract with 
from 30 to 50 parts of water. Such a mixture may also be 
used to allay the pain of herpes zoster and as a lotion for burns 
and blisters, as well as an injection in gonorrhoea, gleet, and 
vaginitis. One part of the fluidextract to four parts of water 
has been employed as a topical dressing in iritis, and diluted 
with glycerin or water this preparation makes a good appli- 
cation for chronic or irritable ulcers. On account of its prop- 
erty of relaxing the bronchial muscles, grindelia is one of the 
remedies most commonly resorted to for the relief of the symp- 
tom asthma, and two or three doses of 1.20 c.c. (20 ni) of the 
fluidextract given every twenty minutes in milk (which pre- 
vents the precipitation of the resin) will often prove effica- 
cious in arresting the paroxysms. Between the attacks this 



602 PHARMACOLOGY AND THERAPEUTICS. 

dose should be taken three times a day. Grindelia may also 
be combined advantageously with other asthmatic remedies, 
such as lobelia and belladonna. Sometimes during the parox- 
ysms it is administered by inhalation. Grindelia leaves steeped 
in a saturated solution of nitre and dried are smoked in 
a pipe or burned on a plate, so that the patient may inhale the 
fumes as they rise. The leaves prepared in this way, and with 
or without the addition of tobacco, lobelia, stramonium, etc., 
may also be rolled into cigarettes and smoked. Cough by imi- 
tation and habit, whooping-cough, and the spasmodic difficulty 
of breathing which accompanies various pulmonary and cardiac 
diseases, hay-asthma, etc., are not infrequently helped by grin- 
delia. It is often of service in subacute bronchitis, chronic 
bronchitis (especially of the aged), emphysema and bronchor- 
rhoea, and is usually prescribed in association with other expec- 
torants. Grindelia is also a remedy of some value in the treat- 
ment of chronic pyelitis, chronic cystitis and other diseases of 
the urinary tract, all along which, in consequence of the excre- 
tion by the kidneys, the local application of the oleo-resin takes 
place. The bitter taste of the drug is perhaps best covered by 
spirit of chloroform. 

ASPIDOSPERMA. 

Unofficial Preparations. 

Aspidosperma. — Aspidosperma (U. S. P., 1890). (Quebracho. 
Iron Wood.) Dose, 0.30 to 2.00 gm.; 5 to 30 gr. 

Fluidextractum Aspidospermatis. — Fluidextract of Aspido- 
sperma. Dose, 0.30 to 2.00 c.c; 5 to 30 HI. 

Aspidosperminum. — Aspidospermine. Dose, 0.015 to 0.03 
gm.; y 4 to y 2 gr. 

Action of Aspidosperma. 

None of the alkaloids fully represent the drug. In the lower 
animals large doses of the bark produce motor paralysis, with 
dyspnoea and finally death from asphyxia. The breathing early 
becomes slower, but deeper; the blood-pressure is not affected 



ERIODICTYON. 603 

until late. There is reason to believe that the relief of dysp- 
noea, which is obtained clinically, is caused by its increasing the 
power of the blood to take up oxygen. 

Therapeutics of Aspidosperma. 

It is a bitter which may aid the appetite, and is a valuable 
remedy when the respiration is embarrassed by emphysema, 
chronic bronchitis, or chronic pneumonia; even uraemic asthma 
is benefited by it. It is not of benefit in dyspnoea of cardiac 
origin. The commercial aspidospermine, which is an impure 
mixture of all the alkaloids, and therefore represents their com- 
bined action, may be given in place of the drug itself. 

PULSATILLA. 

Unofficial Preparations. 

Pulsatilla.— Pulsatilla (U. S. P., 1890). Dose, 0.05 to 0.30 
gm.; 1 to 5 gr. 

Fluidextractum Pulsatilla. — Fluidextract of Pulsatilla. Dose, 
.06 to .30 c.c; 1 to 5 HI. 

Action of Pulsatilla. 
It is said to be very nearly the equivalent of senega, and also 
to paralyze the heart and respiratory centres. 

Therapeutics of Pulsatilla. 
It has been used for the treatment of the symptom asthma, 
convulsive coughs, and ordinary bronchitis. Pulsatilla is a 
favorite remedy for dysmenorrhoea in its various forms, ob- 
structive excepted. The fluidextract has been highly recom- 
mended for orchitis and epididymitis. 

ERIODICTYON. 

ERIODICTYON. — Eriodictyon. (Yerba Santa. Mountain Balm.) 
Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Eriodictyi. — Fluidextract of Eriodictyon. 
Dose, 1 c.c; 15 irt. 



604 PHARMACOLOGY AND THERAPEUTICS. 

Action of Eriodictyon. 

Eriodictyon has long been used in California as a bitter tonic, 
and as a stimulating expectorant. 

Therapeutics of Eriodictyon. 

It has been found useful in chronic bronchitis, and as it 
appears to have something of the anti-spasmodic action of 
grindelia, it is sometimes combined with that drug. In asth- 
matic attacks it has also been employed by smoking. It is an 
excellent vehicle for quinine, concealing its bitter taste. 

CHESTNUT. 

Unofficial Preparations. 

Castanea.— Castanea (U. S. P., 1890). (Chestnut.) Dose, 2 
to 8 gm.; V2 to 2 dr. 

Fluidextractum Castaneae. — Fluidextract of Castanea. Dose, 
2 to 8 c.c; V2 to 2 fl. dr. 

Action of Chestnut Leaves. 
Chestnut leaves are mildly sedative. 

Therapeutics of Chestnut Leaves. 

They are used in whooping-cough, because they are supposed 
to possess anti-spasmodic and expectorant properties. 

OXYGEN. 

Unofficial Preparation. 
Oxygenium. — Oxygen. 

Action of Oxygen. 

The first effect of the inhalation of oxygen in the pure state 
(not as air) is a sensation of warmth in the respiratory pass- 
ages. The appetite is increased, and a feeling of mental ex- 
hilaration and a disposition to greater bodily activity are pro- 



OXYGEN. 605 

duced. The pulse is generally quickened, but may be reduced 
in frequency. It has been shown that the administration of 
oxygen in from 40 to 90 litres (ioj4 to 2^/2 gallons) per day, 
given in two doses and mixed with a determinate quantity of 
air, energizes to some extent the nutritive functions, increases 
the appetite, slightly elevates the temperature, stimulates the 
cardiac movements, and augments the body-weight. These 
effects are chiefly attributable to the action on the blood; the 
red corpuscles being increased in number and stimulated to 
greater organic activity. The capacity of the blood for the 
absorption of oxygen, however, is limited, as the oxygen forms 
a definite chemical compound with haemoglobin, and as soon as 
the latter is saturated, the blood will not take up any further 
amount. With the normal amount of oxygen in the air, the 
normal rapidity of the circulation, and the normal extent of 
lung surface, the blood is almost, but not completely, saturated, 
and it is this small difference between the possible and actual 
saturation which seems to be sufficient to cause some stimula- 
tion to the formation of red corpuscles. In disease the case 
is often very different, and when the absorption of oxygen is 
in any way impeded the blood passes through the pulmonary 
circulation before it has time to absorb all the oxygen it is 
capable of absorbing. There is, therefore, a very evident indi- 
cation for an artificial supply of the gas for the more complete 
oxygenation of the blood. 

Therapeutics of Oxygen. 
Oxygen inhalations are used in cardiac disease, pneumonia, 
pulmonary oedema, emphysema, convulsions, chloroform nar- 
cosis, asphyxia from toxic gases, and in various other condi- 
tions characterized by great lividity or by dyspnoea due to 
causes interfering with the oxygenation of the blood. Even 
though they should fail to avert a fatal issue, they often greatly 
relieve the distress of the patient, and in many instances they 
are of material assistance in tiding over a temporary risk of 
death. In various chronic conditions, as anaemia, albuminuria, 



606 PHARMACOLOGY AND THERAPEUTICS. 

glycosuria and different forms of sub-oxidation, the persistent 
use of oxygen has given excellent results. There seems to be 
satisfactory evidence that it is beneficial in some cases of phthi- 
sis, especially those in which emaciation, dyspeptic symptoms, 
etc., have occurred without marked change in the condition 
of the lungs. When cavities have formed and hectic fever has 
set in, oxygen can be of service simply as a palliative of dysp- 
noea. In the administration of this remedy the gas should be 
allowed to issue in a gentle stream, and it is advisable that the 
inhaler should not be held too near the patient. The ordinary 
inhaling mouth-piece may often be replaced with advantage by 
a glass funnel three or four inches in diameter, and the latter 
should be held, an inch or so away, over the nose and mouth 
of the patient. Small doses of oxygen at frequent intervals 
are usually best. 



Division IX. — Drugs acting on the Digestive Apparatus. 

A. Drugs acting on the Teeth. — For cleaning the teeth pow- 
ders are commonly used, but soaps and liquid dentifrices are 
occasionally employed. Chalk, which acts mechanically, con- 
stitutes the basis of most tooth powders, and charcoal, which, 
however, may abrade the enamel, is also sometimes used for its 
mechanical effect. In order to prevent the decomposition of 
food lodged between the teeth, antiseptics, such as quinine, 
borax and phenol, are often used as ingredients of tooth-pow- 
ders. Astringents such as krameria are employed when the 
gums are inclined to bleed. As iron is apt to blacken the teeth 
and mineral acids and alum are injurious to them, it is advisa- 
ble that these drugs should not be used as gargles for long 
periods and that when prescribed internally they should be 
taken through a glass tube. 

For the relief of toothache local anodynes such as creosote 
or pure carbolic acid may be employed on absorbent cotton, 
which is inserted into the cavity of the carious tooth. There 
is some danger of damage to the dental pulp, and to prevent 



DRUGS ACTING ON DIGESTIVE APPARATUS. 607 

injury to the gums and mouth a pledget of unmedicated cotton 
should be placed over the carbolized cotton. 

B. Drugs acting on the Salivary Glands. — Drugs which in- 
crease the amount of saliva are called Sialogogues; those which 
diminish it, Anti-sialogogues. The saliva is derived from the 
secretion of the parotid, submaxillary and sublingual glands 
and the muciparous glandules of the buccal cavity, and the 
secretions produced by these different glands vary somewhat 
in their physical properties, especially in the degree of their 
viscidity. The function of the submaxillary gland and the 
influences affecting it have been especially studied in the 
dog, and from these researches it is known that the gland 
is largely under the control of the chorda tympani nerve, 
some of whose fibres are of a vaso-dilator character, and 
thus secondarily influence the glandular secretion, while others 
affect the latter directly. This nerve, which has its centre in 
the medulla, may be reflexly excited by stimulation of various 
nerves, and particularly the gastric branches of the vagus and 
the lingual and buccal terminations of the glosso-pharyngeal 
and gustatory nerves. The gland has also a nerve-supply from 
branches of the cervical sympathetic trunk, and these are vaso- 
constrictor in character. The secretion of saliva in the normal 
animal appears to occur only when impulses reach the gland 
cells through the chorda tympani or through the cervical sym- 
pathetic fibres. The positively known modes of action of sia- 
logogues and anti-sialogogues will alone be mentioned here. 

1. Sialogogues acting either on the secretory cells or upon 
the terminations of the nerves in them. — Of these, pilocarpus 
has been the most carefully investigated, and it has been shown 
that it acts on the terminations of the secretory nerves — the 
minute fibrils which ramify between the epithelial cells and 
perhaps even enter them. It is found that its action is not at 
all interfered with by section of all the nerves supplying the 
maxillary gland; also that it acts when injected directly into 
the gland but is prevented from entering the general circula- 
tion. When pilocarpus has been administered, the effect which 



608 PHARMACOLOGY AND THERAPEUTICS. 

stimulation of the chorda tympani or of the sympathetic pro- 
duces is only such as can be readily explained by the vascular 
effects. 

Sialogogues falling under this heading are — 

(0 Pilocarpus. (4) Mercury. 

(2) Muscarine. (5) Nicotine. 

(3) Iodine compounds. (6) Physostigmine. 

The last two probably act also by stimulating the centre in the medulla, 
for section of the chorda tympani decidedly lessens the secretion 
caused by them. Physostigmine soon ceases to cause an increase of the 
secretion, for it tightly contracts the vessels of the gland. 

2. Sialogogues acting reiiexly by stimulating the peripheral 
ends of afferent nerves. — Of these there are two important 
varieties : 

(a) Those stimulating the gustatory and glosso-pharyngeal nerves in 
the mouth : 



(1) All Acids and 

(2) Acid salts. 

(3) Chloroform. 

(4) Alcohol. 



(5) Ether. 

(6) All pungent substances, as 

mustard, ginger, etc. 



(b) Those stimulating the vagus in the stomach: 
Most emetics, especially Antimony and Ipecacuanha. 

3. Anti-sialogogues acting either on the secreting cells or the 
terminations of the nerves in them. — Of these atropine has 
been most studied, and that it acts directly on the gland is 
shown by the fact that it prevents any increase of salivary 
secretion on stimulation of the chorda, although the vessels 
dilate as usual. It appears to act on the terminations of nerve 
fibres in the gland cells, but this action is limited to certain 
definite terminations, since the sympathetic secretory nerve 
fibres are not paralyzed, and it has been ascertained that not all 
the fibres of the chorda tympani are acted upon. Atropine 



DRUGS ACTING ON DIGESTIVE APPARATUS. 609 

would seem, then, to select the terminations of the secretory 
fibres for paralysis, and to leave all others unaffected. 

Anti-sialogogues falling under this heading are — 

(1) Belladonna, 1 (3) Stramonium, and 

(2) Hyoscyamus, (4) Nicotine in excess. 

4. Anti-sialogogues acting reflexly by depressing the peri- 
pheral ends of afferent nerves. — Such are alkalies, opium, and 
any substances allaying irritation of the mouth. Part of the 
effect of opium is due to its depressing action on the medullary 
centre. 

Therapeutics. — A deficiency in the amount of saliva secreted 
is a prominent feature of belladonna poisoning, and it is also 
sometimes a disease in itself, being then probably of nervous 
origin. It is most commonly met -with in fevers, the mouth 
becoming extremely dry and the patient suffering from thirst. 
Remedies which relieve this febrile thirst and impart a sensa- 
tion of coolness are known as Refrigerants. In fever, acid 
drinks, such as lemonade, and beverages containing carbon 
dioxide gas are of service as sialogogues. For the condition 
known as " dry mouth " pilocarpus has been employed, and this 
is also useful in relieving the dryness caused by belladonna or 
atropine. Excessive salivary secretion is seldom met with ex- 
cept as a symptom of poisoning by such drugs as mercury, 
iodine and pilocarpus. In some forms of indigestion the saliva 
acquires a very disagreeable taste, or perhaps the secretion may 
become diminished, but here the correction of the difficulty is 
to be sought in the improvement of the digestion. 

C. Drugs acting on the Stomach. — In the present state of our 
knowledge it is not possible to speak with accuracy of the 
special action of many of the drugs affecting the stomach, and 
it will therefore serve the most useful purpose to divide this 
class of drugs into those affecting the secretion of gastric juice 
as a whole, the secreted contents, the vessels, nerves, and move- 
ments of the stomach, and, lastly, those which are emetics. 

1. Drugs increasing the amount of gastric juice secreted.— 
These are usually called Stomachics, and they include a large 
40 



6io 



PHARMACOLOGY AND THERAPEUTICS. 



variety of agents. The secretion of gastric juice is reflexly 
augmented by all bitter and aromatic substances (which like- 
wise increase the appetite), as well as by stimulants to the 
mouth. Indeed, the smell and taste of food constitute the most 
powerful stimulant to gastric secretion, and substances of 
agreeable flavor cause a marked increase in it by reflexes from 
the mouth and nose. The simple presence of food in the 
stomach also tends to promote the flow. The aromatics appear, 
like other volatile oils, to cause an irritation, hyperemia and in- 
creased secretion and peristalsis, with consequent improvement 
in digestion and absorption. It is thought probable, though this 
has not been proved, that bitters also cause an irritation, lead- 
ing reflexly to the same results. Their effects are, however, 
no doubt largely due to their acrid taste, which is very lasting. 



(a) The drugs which increase the flow of gastric juice are — ■ 



(i) Aromatics. 

(2) Bitters. 

(3) All alkalies (especially potas- 

sium and sodium bicarbon- 
ates, and Spiritus Ammonise 
Aromaticus). 

(4) Alcohol. 



(5) Ether. 

(6) Chloroform. 

(7) Magnesium oxide. 

(8) Magnesium carbonate. 

(9) Pungent substances (pep- 

per, mustard, horse-radish). 



Therapeutics. — Stomachics are extensively employed to fa- 
vorably modify the digestive process in various functional 
disorders. 

2. Drugs decreasing the amount of gastric juice secreted. 



(1) Mineral acids. 

(2) Acetic acid. 



(3) Many of those in the last list 
if given in large doses, e. g., 
alcohol, ether and chloro- 
form. 



Therapeutics. — These drugs, it may be stated, are never 
given for this purpose. It should be noted here that acids and 
alkalies have opposite effects as regards the gastric juice and 



DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 I 

the saliva. While acids diminish the secretion of the gastric 
juice, which is acid, they increase that of the saliva, which is 
alkaline; alkalies, on the other hand, diminish the secretion of 
the alkaline saliva, but increase that of the acid gastric juice. 

3. Drugs altering the composition of the gastric contents. — 
The reaction of the gastric contents may, of course, be modi- 
fied by acids and alkalies. In cases of dyspepsia believed to 
be due to a deficient secretion of hydrochloric acid, diluted 
mineral acids are often prescribed, and they should be taken 
about two hours after eating, so as not to interfere with the 
secretion of the natural acid. If, on the other hand, there 
appears to be an excess of acid in the stomach, alkalies are 
ordered at meal-times, and sodium bicarbonate is the one gen- 
erally selected. When it is thought that the secretion of pepsin 
is at fault, pepsin is administered, and it is customary to pre- 
scribe it with diluted hydrochloric acid. In order to prevent 
fermentation and putrefaction in the stomach, antiseptics are 
sometimes employed, but their field of usefulness is compara- 
tively limited, since doses large enough to accomplish the de- 
sired purpose are liable to prove injurious to the patient. • In 
all varieties of indigestion it should be borne in mind that it 
is of much greater importance to remove the primary cause 
of the trouble than to endeavor to modify the composition of 
the gastric contents. 

Drugs which have been used for this purpose are — 
(1) Phenol. (9) Bismuth salicylate. 



(2) Iodoform. 

(3) Boric acid. 

(4) Creosote. 

(5) Eucalyptus. 

(6) Thymol. 

(7) Resorcinol. 

(8) Salicin. 



(10) Phenyl salicylate (salol). 

(11) Sodium thiosulphate. 

(12) Sodium phenosulphonate. 

(13) Sulphurous anhydride. 

(14) Naphthol. 

(15) Charcoal. 



Charcoal has been considered by many to be useless when it 
is moist, but it has been shown that when moist it is capable 



6l2 PHARMACOLOGY AND THERAPEUTICS. 

of absorbing the gases from decomposing matter almost as 
readily as when in the dry state. 

4. Drugs which dilate the vessels of the stomach. — The vas- 
cularity of the stomach is very readily affected. Thus, me- 
chanical irritation, such as results from the presence of food, 
and particularly peptones, causes a considerable dilatation of 
the vessels. Such increased vascularity, if not excessive, is 
advantageous, since it tends to promote absorption, as well as 
gastric secretion. 

The substances which increase the vascularity of the stomach 
are, all stomachics (except alkalies), diluted mineral acids, the 
drugs. which have been already enumerated as irritants gener- 
ally, and squill, digitalis, colchicum, senega, copaiba, gamboge, 
guaiacum, and veratrine. Most of these, however, produce, 
even in small doses, too powerful an irritant effect to be of 
service in this regard, and practically the only class of drugs 
much employed to increase gastric vascularity is the stomach- 
ics. Even these may induce gastritis, if used to excess, as is 
constantly seen in the case of alcoholics. 

Gastro-intestinal irritants. — It will be found that in the de- 
scription of the action of drugs a large number are designated 
as gastro-intestinal irritants. Caustic potash and mineral acids 
such as nitric and sulphuric acids are very powerful agents of 
this class, and the reader is referred to the sections on these 
drugs for a narration of the local and general symptoms pro- 
duced. There is naturally a great variation in the severity of 
the effects of different gastro-intestinal irritants, and it is 
worthy of note that many of them have no action on the mouth. 

5. Drugs which contract the gastric vessels. — These have 
already been mentioned as being generally astringent. As they 
are much more frequently employed for intestinal disorders 
than for those of the stomach, their detailed consideration is 
deferred to the section on drugs acting on the intestines. 

6. Drugs acting on the nerves of the stomach. — The terminal 
branches of the right and left pneumogastric nerves, which 
supply the stomach, are markedly affected by all powerful gas- 



DRUGS ACTING ON DIGESTIVE APPARATUS. 613 

trie irritants, with the causation of severe pain; while drugs 
which are only mildly irritant to the stomach give rise merely to 
a sensation of warmth, which is often agreeable, rather than 
otherwise. It is, of course, never desirable to produce gastric 
pain. 

(6) Gastric Sedatives. — These drugs are the same as those 
which are local sedatives to other parts of the body. Those 
most used for the stomach are — 



(1) Bismuth subcarbonate. 

(2) Bismuth subnitrate. 

(3) Bismuth salicylate. 

(4) Opium. 

(5) Hydrocyanic acid. 



(6) Carbon dioxide. 

(7) Ice. 

(8) Belladonna. 

(9) Hyoscyamus. 
(10) Stramonium. 



They are most commonly employed in the various painful 
forms of dyspepsia, and all of them, with the possible exception 
of stramonium, are in constant use. 

7. Drugs acting on the movements of the stomach. — As it 
has been observed that the movements of the stomach increase 
proportionately with an increased acidity of the gastric contents, 
it would appear that anything which causes an increase of 
acidity will tend to produce more pronounced movements. In 
addition, stomachics seem to promote the movements, while 
strychnine has been thought to directly stimulate the unstriped 
muscle of the gastric wall. Many authorities, however, believe 
that the latter has no such specific action, but affects the diges- 
tion merely in the same way as the simple bitters. Under this 
class of drugs we have, then, mineral acids, stomachics, and nux 
vomica, and as an adequate amount of gastric movement is 
essential to the digestive process, they are of great value in 
the treatment of dyspepsia. 

Carminatives. — This term is usually applied to substances 
which promote the expulsion of gas from the stomach and in- 
testine by increasing peristalsis, stimulating the circulation, 
and perhaps relaxing the two orifices of the stomach. Many 



6 14 PHARMACOLOGY AND THERAPEUTICS. 

of them are also antiseptics. The most efficient carminatives 
are — 

(i) Stomachics generally, espe- 
cially — 

(2) Aromatics, 

(3) Bitters, 

(4) Pungent substances, 



(5) Asafetida, 

(6) Ammoniac, 

(7) Valerian, 

(8) Camphor and 

(9) Volatile oils. 



8. Emetics. — The act of vomiting is a reflex one, and is con- 
trolled by a nerve centre in the medulla which is situated near 
and closely related to the respiratory centre. This may re- 
spond to afferent impulses reaching it from many organs, as 
the cerebrum (through the special senses), the various parts 
of the alimentary canal, the gall bladder, the genito-urinary 
tract, etc. Disturbance of the mechanism of equilibrium, as 
in vertigo and seasickness, is also a common cause of vomiting. 
Numerous drugs which, by their action on special organs, are 
capable of reflexly stimulating the centre might be included 
among emetics, but it is customary to limit this designation to 
those which produce vomiting either by acting on the stomach 
or on the medullary centre. The first class are sometimes 
calley direct emetics, and the second, indirect emetics, but as 
certain authors use these terms in just the opposite way, making 
the direct emetics those which act on the centre, it will be 
more satisfactory to divide emetics into gastric, or local, and 
central, or general. The following experiments have been 
employed to determine the mode of action of the different 
emetics : 

1. If when the drug has been injected directly into the cir- 
culation (preferably into the carotid artery, on account of its 
nearness to the medulla), it is found that vomiting results very 
promptly, it is concluded that the action is on the centre. If, 
however, a considerable time elapses between the injection and 
the production of vomiting, the conclusion is reached that the 
action is on the stomach and that the drug must have been 
excreted into this organ before vomiting could be caused. 

2. If the smallest amount of the drug which is capable of 



DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 5 

causing vomiting when injected into the circulation is larger 
than is required when it is introduced directly into the stomach, 
it is concluded that the primary action is on the stomach and 
that such vomiting as follows its injection into the circulation 
is due to the fact that a portion of the drug has been excreted 
into the stomach. 

3. If when the stomach has been replaced by a bladder no 
vomiting results from its injection into the circulation, it is 
concluded that the drug acts on the stomach; but if vomiting 
takes place under these circumstances, the inference is that the 
action is on the centre, the vomiting being caused by the con- 
traction of the abdominal muscles. 

4. If, when the drug has been introduced into the stomach, 
a long time elapses before vomiting is produced, it is concluded 
that the action is on the centre, the delay being due to the time 
required for the absorption of the drug. 

It has been found, however, that such experiments are not 
altogether reliable, since some emetics act both locally and cen- 
trally, and, moreover, some of them, in the course of their cir- 
culation through the blood, probably act on some of the numer- 
ous organs from which impulses are transmitted to the vomit- 
ing centre. 



The following are the emetics most commonly used 
Emetics acting on the stomach: 

(1) Yellow mercuric subsul- 

phate. 

(2) Alum. 

(3) Ammonium carbonate. 

(4) Copper sulphate. 



(5) Zinc sulphate. 

(6) Sodium chloride. 

(7) Ipecacuanha. 

(8) Mustard. 

(9) Warm water. 



Ipecacuanha has' often been classed among emetics which act on the 
centre, but it has been demonstrated that emetine, like many other irri- 
tants when injected subcutaneously, has a specific action on the alimen- 
tary canal, and, according to the best authorities, almost all the facts 
brought forward as evidence of the supposed central action of the drug 
have now been disproved. 



6l6 PHARMACOLOGY AND THERAPEUTICS. 



Emetics acting on the medullary centre, 



(i) Apomorphine. 
(2) Tartar emetic. 



(3) Senega. 

(4) Squill. 



Apomorphine and tartar emetic are very powerful, and much 
more depressant than the ordinary local emetics. Tartar 
emetic, however, acts partly on the stomach, and by many it 
is believed that the vomiting caused by it is mainly due to 
gastric irritation. 

Therapeutics. — Emetics are employed for three purposes : 
(1) To evacuate the stomach. This is a very important indi- 
cation in most cases of poisoning. In many instances, however, 
washing out the stomach is preferable to the use of an emetic. 
Emetics sometimes aid the expulsion of foreign bodies which 
have become impacted in the fauces or oesophagus. When with 
a distended stomach there is a feeling of nausea, and also in 
certain cases of sick headache, the emptying of the stomach 
may afford relief. Emetics were formerly employed in a great 
variety of conditions in which their use is now obsolete. (2) 
To expel the contents of the air-passages. Thus, an emetic 
often aids the expulsion of a foreign body lodged in the larynx. 
This class of drugs is especially useful in infants and young 
children, who cannot expectorate well, to clear the air-pas- 
sages in bronchitis, laryngitis, diphtheria, etc. (3) To pro- 
duce nausea. The dose for this purpose is usually about one- 
tenth of the emetic dose. The nauseant stage is employed 
principally in the treatment of catarrhal conditions and coughs, 
and it is indicated when the mucous secretion is deficient or 
thick and tenacious. The milder emetics should be chosen, as 
the nauseant stage is to be prolonged without the production 
of actual vomiting. 

On account of the straining induced by the vomiting, emetics 
are as a rule contra-indicated in cases of aneurism, hernia, peri- 
tonitis, prolapse of the uterus or rectum, and where there is a 
tendency to haemorrhage. 

9. Anti-emetics. — The causes of vomiting being so numerous, 
the number of agents which may serve as anti-emetics is also 



DRUGS ACTING OX DIGESTIVE APPARATUS. 6l/ 

very large ; but. as in the case of emetics., only those substances 
will be considered which act either on the stomach or on the 
vomiting centre. 

Anti-emetics acting on the stomach. — These are all those sub- 
stances which have been already enumerated as having a seda- 
tive influence on the gastric nerves (see p. 613). 

Also some drugs which occasionally appear to have a specific local 
action in arresting vomiting ; such are : 

(1) Cocaine. 8 Phenol. -> 

(2) Cerium oxalate. (9) Chloroform. 

(3) Menthol. (10) Creosote. In 

(4) Wine of ipecac. 1 In (n) Ether. -small 
S Tincture of iodine. Lminute (12) Silver nitrate. doses. 

(6) Arsenic trioxide. j doses. (13) The phenosul- 

- Alcohol. phonates. 



. 



Anti-emetics acting centrally — 

: Opium. (6) Amyl nitrite. 

I 2 Ammonium, (7) Nitroglycerin. 

3 Potassium, and (8) Diluted hydrocyanic acid. 

(4) Sodium bromides. (9) Alcohol. 

(5) Hydrated chloral. 

It will be noticed that some drugs fall under both headings. 

Therapeutics. — The really efficient way to treat vomiting is 
to remove the cause, but. of course., this is not always possible. 
These drugs are. indeed, only palliative, and all are quite uncer- 
tain. Sometimes, however, one will be successful in controll- 
ing vomiting where a number of others have failed. Perhaps 
the most trustworthy anti-emetics are ice. diluted hydrocyanic 
acid, carbon dioxide, bismuth salts, morphine and menthol. 

D. Drugs Acting on the Intestines. — Owing to various circum- 
stances, among which may be mentioned the lack of accurate 
knowledge regarding both intestinal physiology and pathology 
and the fact that many drugs are altered in composition by the 
time they reach this portion of the alimentary tract, it is as yet 



6l8 PHARMACOLOGY AND THERAPEUTICS. 

impossible to classify the drugs acting on the intestines upon a 
physiological basis. We have, in fact, only three important 
divisions : purgatives, antiseptics and astringents. 

One of the methods of experimentation which has been used 
to determine the mode of action of purgatives is as follows: 
The intestine is cut across in two places a short distance apart; 
the isolated part, still attached to the mesentery, is sewed up at 
one end; the other, the open end, is attached to the abdominal 
wall, thus giving a test-tube-like piece of intestine in which 
drugs can be placed. The parts of the bowel on either side of 
the excised piece are then sewed together, so that the whole in- 
testine is the same as before, with the exception of being a little 
shorter. The results of this method not having proved very 
satisfactory, another was devised, which seems more trust- 
worthy. Four ligatures are put around the intestine at equal 
distances apart, so that three pieces are shut off from the rest 
of the intestine and from each other, each of the same length. 
With a fine syringe the drug to be experimented upon is in- 
jected into the middle piece, and the whole returned into the 
abdominal cavity. In a few hours the animal is killed, and the 
state of the interior of the middle piece is contrasted with that 
of the pieces on either side of it. Before these experiments there 
had been much discussion as to whether some purgatives did 
not act only by increasing the action of the muscular coat, and 
others only by stimulating the secretions ; but from such experi- 
ments it appears that probably the majority act in both ways, 
some very slightly on the secretion and powerfully on the mus- 
cle, and others slightly on the muscle and powerfully on the 
secretion. We will first consider intestinal purgatives, then 
intestinal antiseptics, and finally intestinal astringents. 
(C) Purgatives are divided into the following classes: 
Laxatives. — These are substances which slightly increase the 
action of the bowels, chiefly by stimulating their muscular coat. 



They are — 

(i) Whole meal bread. 
(2) Honey. 



(3) Treacle. 

(4) Most fruits, especially^ 



DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 



(5) Tamarind, 


(10) Cassia fistula. 


(6) Fig, 


(11) Sulphur. 


(7) Prune, and 


(12) Magnesium oxide 


(8) Stewed apples. 


(magnesia). 


(9) Manna. 


(13) Olive oil. 



(14) Castor oil (small doses). 

Most of these are well known domestic remedies, and many 
of them are habitually used as articles of diet by persons in- 
clined to constipation. Ergot, physostigma, nux vomica, bella- 
donna, hyoscyamus, and stramonium are also laxatives, but are 
not used except under medical orders. Nux vomica is thought 
to increase the tone of the intestine, and is frequently prescribed 
in association with purgatives. In small doses belladonna in- 
creases peristaltic movements, for the reason that it paralyzes 
the inhibitory fibres of the splanchnics. In moderate doses, 
however, it completely arrests peristalsis, and it is largely given 
for this purpose, especially in combination with opium. Hyos- 
cyamus has a similar action, and in small doses is frequently 
combined with the stronger purgatives in order to counteract 
the irregular contractions they induce, and thus prevent griping. 

Ergot and physostigma are almost never employed for their 
laxative effect. Ergot, however, so often produces diarrhoea 
that its purgative action should be kept in mind. 

Simple Purgatives. — These are somewhat more powerful in 
their action than laxatives; promoting peristalsis and also in- 
creasing intestinal secretion. Some of the laxatives, as castor 
oil and magnesia, when given in large doses act as simple 
purgatives. 



The simple purgatives are — 

(1) Aloes. 

(2) Rhubarb. 

(3) Frangula. 



(4) Cascara sagrada. 
(s) Senna. 
(6) Oxgall. 



All of these are constantly prescribed, and each has its spe- 
cial indications, which will be pointed out when their several 
actions are described. 



620 PHARMACOLOGY AND THERAPEUTICS. 

Drastic Purgatives, often called Cathartics. — These cause 
markedly increased secretion and peristaltic movements, and in 
large doses severe irritation of the intestine, characterized by 
excessive secretion of mucus, pronounced vascular dilatation — 
possibly haemorrhage — and profuse loose stools. This condi- 
tion is attended with intense abdominal pain and tends to pro- 
duce collapse. It is customary to prescribe hyoscyamus or bel- 
ladonna with these drugs on account of the irregular peristalsis 
and severe griping pain which would otherwise be induced. 
The drastic purgatives are as follows : 



(i) Calomel. 

(2) Podophyllum. 

(3) Leptandra. 

(4) Aloes. 

(5) Jalap. 

(6) Scammony. 



(7) Gamboge. 

(8) Oil of turpentine. 

(9) Colocynth. 

(10) Elaterium. 

(11) Croton oil. 



The most powerful are placed last. Some, as jalap, elaterium and 
scammony, are often called hydragogue, because of the large amount of 
secretion they excite. 

Therapeutics. — These drugs are very useful in severe consti- 
pation, and are also frequently given for the purpose of with- 
drawing fluid from the body in consequence of the watery 
evacuations they occasion. Thus, for instance, jalap is in con- 
stant use to fulfill this indication in Bright's disease. 

Saline Purgatives. — The action of these is obscure. They 
differ from the vegetable purgatives in not inducing intestinal 
irritation, unless when given in very large quantities. They 
are absorbed from the intestine very slowly, probably because 
they fail to penetrate into the cells, just as the salts of the heavy 
metals fail to penetrate the red blood-corpuscles. There being 
a distinct affinity between the intestinal epithelium and sodium 
chloride, but only a much weaker one between it and the saline 
cathartics, the latter do not permeate it. It seems certain that 
these cathartics very greatly increase the secretion of intestinal 
fluid, and hinder its reabsorption, so that a large amount of it 



DRUGS ACTING OX DIGESTIVE APPARATUS. 621 

accumulates in the intestine. Secretion goes on till the fluid in 
the intestine has become a 5 or 6 per cent, solution of the drug, 
so that if a very concentrated solution is given, much intestinal 
fluid is secreted. This tends to excite peristalsis mechanically, 
and, in addition, a salt stimulation results from the withdrawal 
of liquid and salts from the cells, as well as from the slight 
absorption of the salt itself; consequently there are produced 
an increased quantity and number of stools of fluid consistency. 
It has been denied that catharsis results if the salts are in- 
jected into the blood, but in medical practice it has been re- 
peatedly demonstrated that magnesium sulphate, administered 
hypodermatically, purges. It is possible that other salines may 
act similarly. The saline purgatives are — 

(1) Potassium and sodium tar- (5) Sodium tartrate. 

trate. (6) Sodium citro-tartrate. 

(2) Potassium bitartrate. (7) Sodium citrate. 



(3) Potassium sulphate. 

(4) Sodium sulphate. 



(8) Sodium phosphate. 

(9) Magnesium sulphate and 

other salts. 



Therapeutics. — These are very largely used as habitual pur- 
gatives and such salts constitute the essential ingredient of the 
various cathartic mineral waters, such as Hunyadi Janos, 
Apenta, Pullna, Friedrichshall, /Esculap, Rubinat, Villacabras, 
etc. The most efficient way of using them is to add some hot 
water to the required dose of the salt or mineral water in a 
tumbler and slowly sip it in the morning. 

Cholagogue purgatives will be considered under the heading 
of Drugs Acting on the Liver. 

Enemata. — Any fluid preparation, injected into the rectum 
is called an enema. It is customary to give purgatives in this 
way when there is danger of their exciting nausea or when, in 
consequence of peritonitis or of obstruction, ulceration or other 
affection of the intestines, it is unadvisable to administer them 
by the mouth. Castor oil, olive oil. soap, aloes and magnesium 
sulphate are among the substances most commonly employed 



62 2 PHARMACOLOGY AND THERAPEUTICS. 

for purgative enemata, enough of the vehicle selected for the 
injection being used to make an enema of at least 350 c.c. 
(}i pint). Such large enemata act mainly by distending the 
bowel and thus exciting peristalsis, though the soap or other 
agent employed no doubt has an irritating effect in addition. 
Attention has recently been drawn, however, to the use of pur- 
gatives by enema with only 4 to 12 c.c. (1 to 3 teaspoonfuls) 
of fluid. With the small enema, of course, there is no distention, 
and the movement is produced solely by the irritant action of 
the drug that is given in it. It is found that colocynthine 
(.01 to .03 gm.; { to/ 2 gr.), aloin (.4 to .5 gm. ; 7 to 8 gr.), 
and cathartinic acid (.6 gm. ; 10 gr.), dissolved in glycerin, will 
cause purgation in periods varying from half an hour to twelve 
hours. Colocynthine acts the most promptly and efficiently, 
the other two being certain in their effects only when the con- 
stipation present is of moderate degree. The action of the 
purgatives is attributed to absorption from the rectum. A 
teaspoonful (4 c.c.) of glycerin injected into the rectum, or the 
same amount given as a suppository, often promptly opens the 
bowels. 

(d) Intestinal Antiseptics. — These are believed to check fer- 
mentation and putrefaction in the intestines and are — 



chlo- 



(1) Naphthol. 


(7) Creosote. 


(2) Bismuth naphtholate. 


(8) Corrosive mercuric 


(3) Naphthalene. 


ride. 


(4) Bismuth salicylate. 


(9) Oil of turpentine. 


(5) Phenyl salicylate. 


(10) Silver nitrate. 


(6) Chlorine. 





Naphthol has been shown to destroy micro-organisms in situ. 
Bismuth naphtholate has not the irritating properties of naph- 
thol, but appears to be equally effective. When pure, naphtha- 
lene is not absorbed, it does not cause toxic symptoms, nor is 
there any change in the urine. Phenyl salicylate, a combina- 
tion of salicylic and carbolic acids, decomposes only in an alka- 
line solution, and this is useful for action in the small intestine, 



DRUGS ACTING ON DIGESTIVE APPARATUS. 623 

Chlorine water has been used for the disinfection of the intes- 
tine in typhoid fever. Creosote is valuable if administered in 
the form of enteric pills, which are soluble only in the intestinal 
fluids. Corrosive mercuric chloride is too poisonous for use, 
save in exceptional cases. Brilliant success has been achieved 
with oil of turpentine in the treatment of typhoid fever. Silver 
nitrate has a limited use as an antiseptic, in its local application 
to dysenteric ulcerations within reach in the rectum and sig- 
moid flexure. The intelligent use of the foregoing drugs has 
greatly improved the success of the treatment of the various 
forms of enteritis, diarrhoea, colitis, dysentery and typhoid 
fever. 

Intestinal Astringents. — These may be described under the 
following heads : 

Astringents acting on the vessels of the intestine. — These are 
the same as those acting on vessels generally. Those employed 
for their action on the intestine are — 

(1) Lead salts. (3) Alum. 

(2) Dilute solutions of silver! (4) Diluted sulphuric acid. 

salts. 

Astringents coagulating albuminous fluids and thus constrict- 
ing the vessels: — 



(1) Tannic acid, and all sub- 

stances containing it, as — 

(2) Krameria, 

(3) Kino, 

(4) Haematoxylon, 

(5) Cinnamon, 

(6) Gambir, and 



(7) Eucalyptus gum. 

(8) Lead salts, 

(9) Silver salts, 

(10) Zinc salts, 

(11) Bismuth salts, 

(12) Copper salts, and especially 

(13) Ferric salts. 



Astringents diminishing the amount of intestinal fluid se- 
creted : 



(1) Opium. (3) Lead salts. 

(2) Coto. (4) Calcium salts. 

The precise action of these is obscure, but it is probable that 
operate in the way indicated. 



they 



624 PHARMACOLOGY AND THERAPEUTICS. 



Astringents diminishing the contractions of the muscular coat 
of the intestines: 



(1) Opium. 

(2) Belladonna. 

(3) Hyoscyamus. 

(4) Stramonium. 



(5) Lead salts. 

(6) Lime. 

(7) Bismuth salts. 



Therapeutics. — The most important point in the treatment of 
diarrhoea is to remove the cause, if possible. Not uncommonly 
the cause is the presence of irritating matters in the intestine, 
and a mild purgative, such as castor oil or rhubarb, is indicated 
to remove them. In many instances a certain amount of en- 
teritis appears to be present in diarrhoea, and remedies serving 
to constrict the dilated vessels and to diminish intestinal move- 
ments and secretion are called for. Hence, it is often advan- 
tageous to combine two or more astringents. Opium has long 
been recognized as an agent of very great value in diarrhceal 
diseases, and is a very frequent ingredient in prescriptions em- 
ployed for them. In such troubles, however, it must be remem- 
bered that drugs constitute only a small part of the treatment. 
It is. essential that the diet should be very carefully regulated, 
and if the case is at all severe, absolute rest and attention to 
keeping the patient warm are called for. If there is a per- 
sistent cause, as tubercular ulceration, palliation of the symp- 
toms is generally all that can be looked for. 

E. Drugs Acting on the Liver. — The liver has several distinct 
functions; viz.: (a) to secrete bile; (b) to form and store up 
glycogen; (c) to form urea; (d) to excrete substances absorbed 
from the intestine; and (e) to destroy poisonous substances 
absorbed from the intestine. 

1. Drugs Influencing the Secretion of Bile. — Because an in- 
creased amount appears in the faeces it does not necessarily 
follow that more bile is secreted. Thus, it may be that the 
gall bladder and ducts have been thoroughly emptied, or that 
the bile which has been poured into the duodenum has been 



DRUGS ACTING ON DIGESTIVE APPARATUS. 



625 



swept along quickly before reabsorption, which is ordinarily 
rapid, has had time to take place. Drugs which increase the 
amount of bile actually secreted are called direct cholagogues. 
They are also sometimes spoken of as hepatic stimulants, but 
this is an unsatisfactory designation on account of the liver's 
having so many different functions. Drugs which simply lead 
to a larger amount of bile being found in the faeces, without 
any additional secretion, are called indirect cholagogues. 

Direct Cholagogues. — These have been studied in fasting, 
curarized dogs. A cannula having been inserted into the bile- 
duct, in order to conduct the fluid outside the body, the amount 
of bile secreted before and after the administration of the drug 
under experiment is noted. A fasting state is essential because 
food itself causes a considerable increase in the biliary flow. 



Direct cholagogues (the most powerful being placed first) are- 



(1) Euonymus. 


(11) Ipecacuanha. • 


(2) Sodium benzoate. 


(12) Diluted nitric acid. 


(3) Sodium salicylate. 


(13) Diluted nitrohydrochloric 


(4) Podophyllin. 


acid. 


(5) Iridin. 


(14) Colocynth. 


(6) Leptandra, 


(15) Colchicum. 


(7) Corrosive mercuric chlo- 


(16) Potassium sulphate. 


ride. 


(17) Rhubarb. 


(8) Sodium sulphate. 


(18) Jalap. 


(9) Sodium phosphate. 


(19) Scammony. 


(10) Aloes. 


(20) Diluted arsenic trioxide. 



There are individual differences among direct cholagogues. Some 
increase the fluidity of the bile, while others have the opposite effect. 
Euonymin, sodium benzoate, sodium salicylate, Harrogate old sulphur 
spring, and Carlsbad water, all markedly increase both the total quan- 
tity and the solids. Podophyllin and iridin, on the other hand, increase 
the solids without affecting the quantity. 



Indirect Cholagogues. — These appear to stimulate the upper 
part of the jejunum and the lower part of the duodenum, thus 
sweeping the bile on before there is time for it to be re- 
absorbed. 



626 PHARMACOLOGY AND THERAPEUTICS. 

They are — (1) Mercury; (2) most Cathartic purgatives, especially 
Calomel. 

Therapeutics. — Cholagogues are used for cases of digestive 
derangement in which hepatic disorder seems to be the cause 
of the trouble, and in order to secure the excretion of the bile, 
as well as the secretion of a proper amount, it is often advanta- 
geous to combine direct and indirect cholagogues. Bile being 
a stimulant to peristalsis, all cholagogues naturally have a pur- 
gative action. In cases of dyspepsia in which the liver is at 
fault careful attention to the diet is a matter of importance, and 
active exercise, such as horseback riding, rowing, etc., is of 
service in promoting the expulsion of bile from the gall-bladder 
and ducts. 

Anti-Cholagogues. — These decrease the quantity of the bile 
secreted, and are sometimes called hepatic depressants. Calo- 
mel, castor oil, gamboge, magnesium sulphate, opium and lead 
acetate have something of this effect, but it is not sufficiently 
pronounced to interfere with the therapeutic actions for which 
they are employed. 

2. Drugs modifying the glycogenic function of the liver. — We 
will here refer to those drugs which cause sugar to appear in 
the urine, and to those drugs which diminish the glycogenic 
function of the liver. 

Drugs causing Sugar to appear in the Urine. — Until re- 
cently it was assumed that all these drugs acted on the liver, 
probably by increasing the amount of sugar made from the 
hepatic store of glycogen; but now we have reasons for think- 
ing that sometimes the pancreas may be the organ at fault in 
diabetes, for its excision causes sugar to appear in the urine, 
and other symptoms of diabetes; also it has been suggested 
that perhaps some perversion of processes going on in muscles 
may cause diabetes. Therefore it is rash to assume that all 
drugs causing sugar to appear in the urine (glycosuria) must 
act on the liver. What little can be stated as to the mode of 
action of these drugs will be given when each individual drug 
is considered. 



CALUMBA. 62J 

The drugs stated to cause glycosuria have already been mentioned 
(see p. 515). 

' Depressants of the Glycogenic Function. — Phosphorus, arsenic, 
and antimony diminish and may even arrest the formation of gly- 
cogen by the liver ; they also cause fatty degeneration of the organ. In 
many instances of diabetes opium, morphine and codeine have a 
marked effect in diminishing the quantity, of sugar in the urine. 

3. Drugs modifying the formation of urea by the liver. — The 
quantity of urea excreted by the urine is increased by phos- 
phorus, arsenic, antimony, ammonium chloride, and iron. Phos- 
phorus may also lead to the appearance in the urine of leucin 
and tyrosin. There is some evidence that this drug causes an 
increase of the urea through its action on the liver, for in phos- 
phorus poisoning that organ undergoes extreme fatty degenera- 
tion, and jaundice supervenes. Whether the other drugs act 
through the liver is uncertain, but antimony and arsenic, like 
phosphorus, are capable of producing general fatty degenera- 
tion. Very large doses of all these substances are required to 
increase the amount of urea in the urine, and they are not 
employed therapeutically for this purpose. 

Opium, colchicum, alcohol and quinine are among the drugs 
stated to increase the quantity of urea excreted. 

C. Drugs Acting on the Stomach. 

(a) Stomachics. 

CALUMBA. 

CALUMBA.— Calumba. (Columbo.) Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Calumbae. — Fluidextract of Calumba. 
Dose, 2 c.c; 30 ni . 

2. Tinctura Calumbae. — Tincture of Calumba. Dose, 4 c.c; 
1 fl. dr. 

Action of Calumba. 
External. — Calumba is slightly antiseptic and disinfectant. 
Internal. Mouth. — Calumba is a typical simple bitter. It 



628 PHARMACOLOGY AND THERAPEUTICS. 

irritates the terminations of the gustatory nerves in the papillae 
and mucous membrane of the tongue, increasing the appetite 
and reflexly stimulating the salivary and gastric secretions. 
The reflex action of bitters has recently been particularly stud- 
ied. In these experimental researches there was employed Pav- 
low's method of sham feeding in a dog in which oesophagotomy 
had been performed and a gastric fistula also established. The 
bitter substances, therefore, did not pass into the stomach, and 
the reflex effects of their presence in the mouth could be accu- 
rately judged. It was found that if a little wad of wool soaked 
in tincture of gentian was put into the mouth immediately 
before food was administered, a marked stimulant effect upon 
gastric secretion resulted; but if the bitter was used fifteen to 
thirty minutes before the meal it was quite inefficacious. It is 
concluded, therefore, that these substances have the power of 
rendering gustatory sensations more acute and of exercising a 
temporary stimulant effect upon gastric secretion; for this pur- 
pose they should be given in small doses and in the form of 
tinctures (.60 to 1.20 c.c. ; 10 to 20 drops). 

G astro -intestinal Tract. — The gastric nerves are probably 
stimulated, and a sort of artificial hunger produced. The diges- 
tion is improved, as there is vascular dilatation, and the secre- 
tion of gastric juice is increased by this, as well as by the 
arrival in the stomach of an increased amount of alkaline 
saliva; while the gastric movements also appear to be some- 
what augmented. The stronger bitters have some tendency to 
increase intestinal peristalsis and act on the bowels. The secre- 
tions of the pancreas and the bile are unaffected by any of them. 
They are more or less antiputrefactive, and, by removing mor- 
bid states of the intestinal mucous membrane, they favor assim- 
ilation. Too large doses are apt to interfere with digestion, 
and their long-continued use induces gastric catarrh and con- 
sequent indigestion. Calumba is rapidly absorbed. Like some 
other bitters, it is feebly anthelmintic. 

Blood and Circulation. — The leucocytes of the blood are 
markedly augmented, which may possibly assist in the absorp- 
tion of food, and the red corpuscles are also stated to be in- 



CALUMBA. 629 

creased. Calumbin, when injected intravenously, has the effect 
of increasing the blood-pressure by stimulation of the vasomotor 
centre. 

Berberine, an alkaloid found in calumba and many other vege- 
table drugs, is, in large doses, an irritant which gives rise to 
a yellow discoloration of the intestines and urine. It is never 
fatal when given by the mouth, but when injected subcutane- 
ously or intravenously it causes convulsions and paralysis, and 
death is likely to result by asphyxia from failure of the respi- 
ratory centre. 

Therapeutics of Calumba. 

Calumba and other simple bitters are used with good effect 
in atonic dyspepsia, and are often of material service in cases 
of anaemia and weakness, and in convalescence from acute dis- 
eases. In general, they may be said to be most advantageous 
in debilitated conditions in which the stomach participates in a 
feebleness of all the various organs. Calumba is the mildest 
agent of its class, and may be used with safety in many in- 
stances when other bitters would be too irritating. The tinc- 
ture in doses of a few drops and the infusion in 4 c.c. (1 fl. dr.) 
doses are occasionally used for the relief of the vomiting of 
pregnancy and of seasickness. In diarrhoea due to relaxation 
of the mucous membrane (without the presence of any inflam- 
mation), and in the relaxation of the bowels following acute 
affections of the intestines, the tincture may often be employed 
with benefit. In such cases it is sometimes combined with the 
tincture of deodorized opium. To permanently cure a disposi- 
tion to the accumulation of flatus in the intestines an infusion* 
is highly recommended which is made with calumba, ginger, 
senna and boiling water. Thread worms may be treated by the 
rectal injection (the patient being in the knee-chest position) 
of 240 c.c. ( J / 2 pint) of the infusion (B. P.), which is made 
with calumba, 1 ; cold water (to avoid extracting the starch), 20. 

The use of bitters ought to be combined, whenever possible, 
with measures designed to relieve the cause of the dyspepsia. 
They should not be given in too concentrated form, nor em- 



63O PHARMACOLOGY AND THERAPEUTICS. 

ployed for too long a time continuously. They are contra- 
indicated in acute and subacute inflammation of the stomach, or 
when the secretion of gastric juice is diminished as the result 
of organic disease. Neither should they be prescribed as stom- 
achics during the continuance of acute febrile diseases. Should 
the appetite remain good, although the digestion is impaired, it 
will usually indicate that the indigestion is intestinal, and rem- 
edies other than the bitters are called for. 

GENTIAN. 
GENTIANA. — Gentian. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Extractum Gentianae. — Extract of Gentian. Dose, 0.250 
gm. (250 milligm.) ; 4 gr. 

2. Fluidextractum Gentianae. — Fluidextract of Gentian. Dose, 
1 c.c.; 15 TTl. 

3. Tinctura Gentianae Composita. — Compound Tincture of 
Gentian. Dose, 4 C.C.; 1 fl. dr. 

Action of Gentian. 

Gentian has the same action as calumba and other simple 
bitters. 

Therapeutics of Gentian. 

It is given in the same kinds of cases as the other drugs of 
its class, and, on account of its more agreeable flavor, it is 
perhaps more widely used than any of the rest. The compound 
tincture is esteemed an excellent vehicle for the administration 
of codliver oil, the digestion and assimilation of which it serves 
to promote. For potassium iodide the compound infusion (B. 
P. : Gentian, 8 ; dried bitter orange peel, 3 ; cardamom, 1 ; alco- 
hol — 45 per cent. — 80) is a good vehicle in cases where its tonic 
effects would be useful. 

QUASSIA. 

QUASSIA.— Quassia. Dose, 0.5 gm.; 7y 2 gr. 



CALAMUS. 63 I 

Preparations. 

1. Extractum Quassiae. — Extract of Quassia. Dose, 0.065 gm. 
(65 milligm.) ; 1 gr. 

2. Fluidextr actum Quassiae. — Fluidextract of Quassia. Dose, 
0.5 c.c; 8 m.. 

3. Tinctura Quassiae. — Tincture of Quassia. Dose, 2 c.c; 
30 TTl . 

Action of Quassia. 

Quassia is an aromatic bitter stomachic, which has the same 
action as calumba and gentian. In doses of .12 gm. (2 gr.) 
quassin is said in many individuals to produce burning in the 
throat and stomach, discomfort, headache, nausea and vom- 
iting. 

Therapeutics of Quassia. 

As it contains no tannic acid, quassia is often prescribed with 
iron. On account of its intense bitterness it is objectionable 
to some patients, but it is a very useful remedy in the class of 
cases in which these bitters are given. It is regarded as espe- 
cially serviceable in the dyspepsia of inebriates, and whenever 
there are much relaxation and digestive torpor it is apt to be 
efficient as a stomachic tonic. A goblet turned out of quassia- 
wood may be used, by allowing water to stand in it for a num- 
ber of hours, for making an extemporaneous infusion of the 
drug. The infusions of quassia, gentian and calumba are fre- 
quently employed as vehicles for the administration of acids or 
alkalies, according to the requirements of the case, in gastric 
indigestion. 250 c.c. (y 2 pint) of the infusion (1 to 100 of cold 
water to avoid extraction of too much of the bitter principle), 
injected into the rectum, with the patient in the knee-chest posi- 
tion, may be used with advantage against thread-worms. 

CALAMUS. 
CALAMUS. — Calamus. (Sweet Flag.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Calami. — Fluidextract of Calamus. Dose, 1 
c.c; 15 TTL. 



632 PHARMACOLOGY AND THERAPEUTICS. 

Action of Calamus. 
Sweet flag is a simple bitter and feeble aromatic. 

Therapeutics of Calamus. 
It is used with advantage in pain or uneasiness in the stom- 
ach or bowels arising from flatulence, or as an adjuvant to 
purgative medicines. 

BARBERRY. 
. BERBERIS.— Berberis. (Barberry.) Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Berberidis. — Fluidextract of Berberis. Dose, 
2 c.c; 30 Hi. 

Action of Barberry. 
It is in moderate doses a stomachic tonic, and somewhat 
astringent. It is also credited with alterative qualities. In 
large amounts it is a gastro-intestinal irritant. 

Therapeutics of Barberry. 
Locally it has been used in conjunctivitis, and internally in 
a variety of chronic conditions for its alterative effect. 

CASCARILLA. 

Unofficial Preparations. 

Cascarilla.— Cascarilla (U. S. P., 1890). Dose, 0.60 to 2 
gm.; 10 to 30 gr. 

Infusum Cascarillse. — Infusion of Cascarilla. Dose, 30 c.c; 
1 11. oz. 

Tinctura Cascarillae. — Tincture of Cascarilla. Dose, 2 to 8 
c.c; y 2 to 2 fl. dr. 

Action of Cascarilla. 
Cascarilla has astringent properties, on account of its tannic 
acid, and, because of its bitter principle cascarillin, it improves 
the appetite and digestion like calumba, while the volatile oil 



CUSPARIA. 633 

in its composition gives it an increased stomachic and carmina- 
tive effect. It is an agreeable aromatic tonic, without unpleas- 
ant bitterness. Large doses are somewhat irritant. 

Therapeutics of Cascarilla. 
Its medicinal uses are similar to those of calumba. It is some- 
what difficult to dispense, as the infusion (1 to 20) quickly de- 
composes unless the tincture (1 to 15) is added to it, and acids 
precipitate the resin from the tincture. 

CHIRATA. 
CHIRATA.— Chirata. (Chiretta.) Dose, 1 gin.; 15 gr. 

Preparation. 
Fluidextractum Cbiratse. — Fluidextract of Chirata. Dose, 1 
c.c; 15 1TL- 

Unofficial Preparation. 
Tinctura Chiratae (U. S. P., 1890). — Tincture of Chirata. 
Dose, 2 to 8 c.c; y 2 to 2 fl. dr. 

Action of Chirata. 
Chirata is a simple bitter, like calumba. 

Therapeutics of Chirata. 
It has the same uses as calumba and gentian, and in India, 
where it is more frequently employed than elsewhere, it is 
given considerably as a substitute for cinchona. It diminishes 
flatulency and acidity, and is thought to be especially service- 
able in the dyspepsia of gouty subjects. As it contains no tan- 
nic acid, it can be prescribed in combination with the iron salts. 

CUSPARIA. 

Unofficial Preparation. 
Cusparise Cortex.— Cusparia Bark. (Angustura Bark.) Dose, 
.60 to 2.40 gm.; 10 to 40 gr. 



634 PHARMACOLOGY AND THERAPEUTICS. 

Action of Cusparia. 
Cusparia bark is an aromatic bitter. It has been supposed 
to possess valuable antiperiodic properties, but there seems no 
more reason to ascribe such action to it than to the simple 
bitters. In large quantities it is a gastro-intestinal irritant. 

Therapeutics of Cusparia. 
It is a stimulant to digestion, and in order to prevent its 
causing nausea it is often combined with aromatics. It is given 
in large doses as an antiperiodic in South America, and it is 
said to be peculiarly efficacious in bilious diarrhoeas and trop- 
ical dysentery. It is used for the manufacture of Angustura 
Bitters. 

SERPENTARIA. 

SERPENTARIA.— Serpentaria. (Virginia Snakeroot.) Dose, 1 
gm.; 15 gr. 

Preparations. 

1. Fluidextractum Serpentariae. — Fluidextract of Serpentaria. 
Dose, 1 c.c.; 15 n\. 

2. Tinctura Serpentariae. — Tincture of Serpentaria. Dose, 4 
c.c; 1 fl. dr. 

Action of Serpentaria. 
Serpentaria is an astringent bitter and stimulating expector- 
ant. In large doses it causes nausea, vomiting, colic, flatulence 
and rectal tenesmus, with frequent, but not watery stools. The 
irritant action appears to produce gas rather than fluid. It is 
slightly diuretic and diaphoretic. 

Therapeutics of Serpentaria. 
It was formerly regarded as an antidote to snake poison, but 
is without value in this capacity, and a number of other virtues 
have been attributed to it which it quite likely does not possess. 
It may be employed as a bitter stomachic, and is of consider- 
able utility as a stimulant expectorant in capillary bronchitis 
and in pneumonia of low grade, when ammonium carbonate is 
combined with it. It is seldom administered alone. 



CANELLA. 63 5 

DANDELION. 

TARAXACUM.— Taraxacum. (Dandelion.) Dose, 8 gm.; 120 gr. 

Preparations. 

1. Extractum Taraxaci. — Extract of Taraxacum. Dose, 1 
gm.; 15 gr. 

2. Fluidextractum Taraxaci. — Fluidextract of Taraxacum. 
Dose, 8 c.c; 2 fl. dr. 

Action of Dandelion. 
Dandelion is a simple bitter, promoting appetite and diges- 
tion. For a long time it was supposed to have some action in 
increasing the secretion of bile, but it has been shown that this 
idea has no foundation in fact. It is a mild laxative, however, 
and as such may, by reflex stimulation, have some effect in tend- 
ing to evacuate the gall bladder. The vulgar name by which 
dandelion is known both in England and France suggests that 
it may be diuretic. 

Therapeutics of Dandelion. 
It is not nearly as frequently employed now as formerly, but 
is still occasionally prescribed as a laxative in catarrhal jaun- 
dice, in ascites from hepatic disease, and in some forms of dys- 
pepsia. By German physicians particularly it has been given 
in combination with ammonium chloride. Its practical utility 
as a diuretic seems to be very limited. 

CANELLA. 

Unofficial Preparation. 

Canellae Cortex. — Canella Bark. Dose, 1 to 4 gm.; 15 to 
60 gr. 

Action of Canella. 
Canella is an aromatic bitter stomachic. 

Therapeutics of Canella. 
It is not much used. When it is prescribed, it is almost in- 
variably in association with other bitters or, for its tonic action, 
with purgatives which tend to debilitate. 



636 PHARMACOLOGY AND THERAPEUTICS. 

BAEL FRUIT. 

Unofficial Preparation. 
Belae Fructus. — Bael Fruit. Dose, 1 to 2 gm.; 15 to 30 gr. 

Action of Bael Fruit. 
Very little is known in regard to the principles or action of 
bael fruit, but it is thought that it may perhaps have some effect 
as a bitter; it appears to be slightly astringent. 

Therapeutics of Bael Fruit. 
In India bael fruit, although it contains very little tannic acid, 
is a very popular remedy for diarrhoea and dysentery, especially 
when unattended by fever. Various preparations of it are 
employed, particularly a decoction boiled down until the water 
containing the fresh fruit is reduced to one-quarter its original 
quantity, and sometimes the fruit is eaten in its natural state. 
The imported bael fruit is probably of no therapeutic value. 

CLOVES. 

CARYOPHYLLUS.— Cloves. Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

OLEUM CARYOPHYLLL— Oil of Cloves. Dose, 0.2 c.c; 3 m.. 
EUGENOL.— Eugenol. Dose, 0.2 c.c; 3 Til. 

Unofficial Preparations. 
Infusum Caryophylli. — Infusion of Cloves. Dose, 15 to 30 
c.c; y 2 to 1 fl. oz. 
Eugenol Acetamidum. — Eugenol Acetamide. 

Action of Cloves and Oil of Cloves. 
External. — Oil of cloves has antiseptic and parasiticidal 
properties. Rubbed into the skin, or applied to mucous mem- 
branes, it is rubefacient and irritant, producing hyperemia, and 
the burning sensation to which it at first gives rise is followed 
by anaesthesia of the part. The action on the skin is mainly 
one of sensory irritation. 






CLOVES. 637 

Internal. Mouth. — In the mouth the effects just mentioned 
are naturally produced, and, in addition, the nerves of taste and 
smell are stimulated and the salivary glands excited to increased 
secretion. 

Stomach. — Oil of cloves is preeminently stomachic and car- 
minative, and its gastric effects constitute the most important 
part of its action. It has the characteristic action of the vola- 
tile oils, appearing to induce dilatation of the blood-vessels, to 
stimulate the secretion of the gastric glands, and to accelerate 
the movements of the stomach, in consequence of which there 
is more or less eructation of gas. The oil also acts as an anti- 
septic here, as elsewhere, and it thus no doubt hinders the de- 
velopment of yeasts and other organisms. As soon as it reaches 
the stomach a grateful sensation of warmth is experienced, and 
its whole action in the organ tends to increase appetite and 
digestion. By the stimulation of the gastric nerves the heart 
is reflexly stimulated to a certain extent, and the rate and force 
of the heart are consequently moderately increased. 

Intestine. — Similar effects are believed to be produced in the 
intestine, though it is not positively known whether the peri- 
staltic movements of the latter are increased by the volatile 
oils. At all events, flatulence and distention are relieved, an 
effect which may be due in part at least to the antiseptic action. 
It is well known that the colic caused by some of the more pow- 
erful purgatives is much diminished by the administration with 
them of oil of cloves and other volatile oils. It has been shown 
that the intestine, like the stomach, absorbs more rapidly in the 
presence of small quantities of these oils. Oil of cloves, like 
others of its class, is capable when given in sufficient quantity 
of exciting gastro-enteritis. 

Excretion. — Oil of cloves is absorbed from the intestine, and 
in the course of its excretion exerts more or less irritant action 
on the kidneys and respiratory passages, the secretions of which 
it tends to disinfect. 

Eugenol has the same general action as the oil of cloves, of % 
which it is one of the chief constituents. 



638 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Cloves and Oil of Cloves. 

External. — The expensiveness of oil of cloves is an objection 
to its free or frequent use. On account of its local anaesthetic 
action it is sometimes employed as an external application for 
neuralgias. It is more or less used in combination with other 
rubefacients, counter-irritants and antiseptics. It is of service, 
in an ointment made with lanolin, in some cases of eczema, 
and in lupus vulgaris its repeated application is said to cause 
separation of the epithelium and retrocession of the nodules. 
As a parasiticide it has been used for pediculosis. It is one 
of the remedies most commonly resorted to for the relief of the 
pain of carious teeth, and is an important constituent of many 
" toothache drops." It is sometimes employed to give a pleas- 
ant odor to liniments. 

Internal. — In cooking, cloves are largely used for seasoning. 
The oil or infusion (B. P., 1 to 40) may be given as a stom- 
achic or as a carminative for the relief of gastric or intestinal 
pain, and the oil is sometimes combined with preparations of 
scammony, of castor oil, and of colocynth, to prevent griping. 
Its aromatic qualities render it an agreeable adjuvant to other 
remedies besides purgatives, and in minute doses it has been 
successfully given for severe vomiting. In gastric fermenta- 
tion the following combination has proved quite efficient: .06 
c.c. (1 1T L) each of the oils of cloves, cinnamon and peppermint, 
with .06 c.c. (1 ni) of creosote, administered three times a day 
in a soft capsule containing about ^6 c.c. (6 ^l) of olive oil. 

Eugenol acetamide, a crystalline substance obtained from 
eugenol-acetic-ethyl-ester by treating with a strong solution of 
ammonia, has been used in dentistry and minor surgery. It is 
said to be not only an active antiseptic, but a powerful local 
anaesthetic, analogous to cocaine in its action. 

ALLSPICE. 

PIMENTA. — Pimenta. (Allspice.) Dose, 1 gm.; 15 gr. 
OLEUM PIMENTO.— Oil of Pimenta. Dose, 0.2 c.c; 3 m,. 



NUTMEG AND MACE. 639 

Action of Allspice. 
The same as that of cloves and oil of cloves. 

Therapeutics of Allspice. 
The uses, as well as the action, are the same as those of cloves 
and oil of cloves. 

NUTMEG AND MACE. 
MYRISTICA. — Nutmeg. Dose, 0.500 gm. (500 milligm.) ; 7Y 2 gr. 

Preparations. 
Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15 gr. 
Fluidextractum Aromaticum. — Aromatic Fluidextract. Dose, 
1 c.c.; 15 m,. 

OLEUM MYRISTIOdE.— Oil of Nutmeg. Dose, 0.2 c.c; 3 HI. 

Unofficial Preparations. 

Spiritus Myristicae. — Spirit of Nutmeg, U. S. P., 1890. 
(Essence of Nutmeg.) Dose, 0.06 to 0.18 C.C.; 1 to 3 TTj,. 

Oleum Myristicae Expressum. — Expressed Oil of Nutmeg. 
Dose, 0.10 to 0.30 gm.; 2 to 5 gr. 

Macis. — Mace (U. S. P., 1890). Dose, 0.30 to 1.20 gm.; 5 
to 20 gr. 

Action of Nutmeg and Mace. 
Oil of nutmeg has the same action as that of other aromatic 
oils. Its effects after absorption appear to render it more toxic 
than most volatile oils. In addition to its aromatic and carmina- 
tive qualities, it is possessed of considerable narcotic power, and, 
injected into the circulation of the dog, it has been found to 
produce profound sleep, with slowing of the circulation, and, 
if the dose is sufficiently large, loss of reflex activity. 

Therapeutics of Nutmeg and Mace. 
The expressed oil of nutmeg may be rubbed on the skin as 
a rubefacient in rheumatism, neuralgia and paralysis, and in 
plasters it is used as a sweet-smelling stimulant. For mild 



64O PHARMACOLOGY AND THERAPEUTICS. 

cases of ringworm a liniment composed of one part of the oil 
to three of olive oil may be employed as an elegant antipara- 
siticide. In itching and painful haemorrhoids the following oint- 
ment affords relief: Powdered nutmeg, 8; tannic acid, 4; pe- 
trolatum, 31. Nutmeg and mace are much used in cooking, as 
their volatile oil renders them agreeable stomachics. In medi- 
cine powdered or grated nutmeg, or the volatile oil, is given as 
a carminative and anodyne for the relief of nausea or colic 
and, combined with other remedies, of diarrhoea. The narcotic 
properties of the drug make it of service at times in the treat- 
ment of delirium tremens. 

CINNAMON. 
CINNAMOMUM SAIGONICUM.— Saigon Cinnamon. Dose, 0.250 
gm. (250 milligm.) ; 4 gr. 

Preparations. 

1. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 
15 gr. 

2. Tinctura Cinnamomi. — Tincture of Cinnamon. Dose, 2 
c.c; 30 tt\.. 

3. Fluidextractum Aromaticum. — Aromatic Fluidextract. 
Dose, 1 c.c; 15 Trt. 

CINNAMOMUM ZEYLANICUM.— Ceylon Cinnamon. Dose, 0.250 
gm. (250 milligm.) ; 4 gr. 

OLEUM CINNAMOMI.— Oil of Cinnamon. Oil of Cassia. Dose, 
0.05 c.c; 1 TTt- 

Preparations. 

1. Aqua Cinnamomi. — Cinnamon Water. Dose, 16 cc; 4 
fl. dr. 

2. Spiritus Cinnamomi. — Spirit of Cinnamon. Dose, 2 c.c; 
30 1TL. 

CINNALDEHYDUM.— Cinnamic Aldehyde. Dose, 0.05 C.C. J 1 1TL- 

UnofUcial Preparation. 
Cinnamomum Cassia (U. S. P., 1890). — Cassia Cinnamon. 
(Cassia Bark.) Dose, 0.250 gm.; 4 gr. 



HORSE RADISH. 64 1 

Action of Cinnamon. 
Oil of cinnamon has the same action as other aromatic oils. 
The bark, on account of its tannic acid, has considerable astrin- 
gent property. 

Therapeutics of Cinnamon. 
Finely powdered cinnamon is sometimes of service in arrest- 
ing nausea and vomiting, and in doses of 4 to 6 gm. (60 to 90 
gr.), night and morning, is said to be efficient in acute dysen- 
tery. Cinnamon is much used as an ingredient of carminative 
and astringent powders and mixtures, and is also combined with 
purgatives to prevent griping. On account of its tannic acid 
it is incompatible with iron preparations. It has been claimed 
that in large doses it is of value in the palliative treatment of 
carcinoma of various internal organs. Spirit of Cinnamon, 
although in full strength very irritant, has been utilized, when 
dissolved in retinol, as a surgical dressing, and it has consid- 
erable antiseptic value. For counter-irritation, especially in 
children, a spice plaster made by placing Aromatic Powder 
between two layers of flannel and moistening it with hot whis- 
key or other form of alcohol, is sometimes employed. Spice 
plasters may also be obtained already prepared for use. Oil of 
cinnamon dissolved in one of the liquid petroleum preparations 
has been recommended as an injection in gonorrhoea. 

HORSE-RADISH. 

Unofficial Preparation. 
Armoracia. — Horse-Radish. Dose, 1.20 to 2 gm.; 20 to 30 gr. 

Action of Horse-Radish. 
The action of horse-radish is similar to that of mustard. It 
especially stimulates the secretion of urine. 

Therapeutics of Horse-Radish. 
It may be employed as a rubefacient and counter-irritant. 
As a condiment it is used particularly with meats and raw 
42 



642 PHARMACOLOGY AND THERAPEUTICS. 

oysters. It is occasionally given in dropsy attended with en- 
feebled digestion and general debility, and the addition of grated 
horse-radish to cider renders it actively diuretic. The com- 
pound spirit (B. P., scraped horse-radish root, 10; bitter orange 
peel, 10; nutmeg, 1; alcohol, 192; water, 196; dose, 4 to 8 c.c; 
1 to 2 fl. dr.) is used for flavoring and as a carminative. 

SUMBUL. 
SUMBUL.— Sumbul. (Musk Root.) Dose, 2 gm.; 30 gr. 

Preparations. 

1. Extractum Sumbul. — Extract of Sumbul. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

2. Fluidextractum Sumbul. — Fluidextract of Sumbul. Dose, 
2 c.c; 30 HI. 

Unofficial Preparation. 
Tinctura Sumbul (U. S. P., 1890). — Tincture of Sumbul. 
Dose, 4 to 16 c.c; 1 to 4 fl. dr. 

Action of Sumbul. 
Little is known positively of the effects of sumbul on the 
system, but its action appears to resemble that of the volatile 
oils in general, and it is usually classed with the substances 
having malodorous oils, such as asafetida and valerian. It is 
stomachic and carminative, and is regarded more particularly 
as an antispasmodic and nerve tonic. It stimulates appetite, 
improves digestion, and allays irregular nerve action. It is 
said to directly influence the cerebro-spinal nerve centres, and 
thus control spasm, restlessness and incoordination of movement 
dependent upon disturbances of their circulation. Its resinous 
and volatile constituents, it is believed, are excreted by the 
mucous surfaces of the kidney and air-passages; stimulating 
their vessels and controlling excessive secretions. 

Therapeutics of Sumbul. 
Sumbul may be given for its carminative effects in colic and 
flatulence. It is thought to be especially beneficial in depressed 



LAVENDER. 643 

or excitable conditions of the nervous system, and among the 
affections in which it has been recommended are neuralgia, 
facial, ovarian or sciatic, occurring in hysterical subjects, hys- 
teria in general, chlorosis, neurotic migraine, functional de- 
rangement of the heart, alcoholic and other insomnia, chorea, 
catarrhal and spasmodic conditions of the respiratory and 
genito-urinary tracts, nervous dyspepsia, neurasthenia, and the 
unrest of nervous females. It is usually associated with such 
other remedies as may be indicated by the condition present. 
In Russia it is highly esteemed as a stimulant in atonic dyspep- 
sia, asthenic diarrhoea, dysentery and typhoid fever. 

LAVENDER. 

OLEUM LAVANDULA FLORUM.— Oil of Lavender Flowers. 
Dose, 0.2 c.c; 3 n\,. 

Preparations. 

1. Spiritus Lavandulae. — Spirit of Lavender. Dose, 2 c.c; 
30 TIL 

2. Tinctura Lavandulae Composita. — Compound Tincture of 
Lavender. Dose, 2 C.C.; 30 1T1 . 

Unofficial Preparations. 
Aqua Lavandulae. — Lavender Water. 

Oleum Lavandulae.— Oil of Lavender. Dose, .06 to .30 c.c; 
1 to 5 n\. 

Action of Oil of Lavender Flowers. 

This has the same action as oil of cloves and other aromatic 
volatile oils. 

Therapeutics of Oil of Lavender Flowers. 
In nervous headache a few drops of the oil are sometimes 
rubbed upon the temples. Its principal external use is as an 
agreeable stimulating ingredient of liniments and ointments, 
and the compound tincture is largely employed to color the 
Lotion Rubra {see p. 426) and other red lotions. The com- 



644 PHARMACOLOGY AND THERAPEUTICS. 

pound tincture, which is a very palatable carminative and gas- 
tric stimulant, is in constant use in the treatment of nausea, 
flatulence, gastralgia, etc., and as an adjuvant or corrigent of 
other medicines. In hysterical and other nervous conditions it 
is a pleasant antispasmodic, and it is used as a stimulant in 
fainting. As a tranquilizing remedy in various disturbed states 
of the system it is not infrequently combined with Hoffman's 
anodyne (Spiritus ^Etheris Compositus), which it renders less 
disagreeable to take. To calm nervous headache the oil may 
be used internally as well as externally. Lavender water, which 
is an alcoholic solution of the oil with other volatile substances, 
is a well-known perfume and deodorant. 

Oil of Lavender (B. P.) is usually distilled from the flowers 
and flower-stems conjointly, and consequently is inferior in 
quality to that obtained from the flowers exclusively. 

BERGAMOT. 

Unofficial Preparation. 
Oleum Bergamottae (U. S. P., 1890). — Oil of Bergamot. 

Action of Oil of Bergamot. 
Oil of bergamot has the same action as other aromatic vola- 
tile oils. 

Therapeutics of Oil of Bergamot. 
Although possessing the carminative and stimulant properties 
of other similar oils, it is employed chiefly, if not exclusively, 
as a perfume. 

' PEPPERMINT. 

MENTHA PIPERITA.— Peppermint. Dose, 4 gm.; 60 gr. 
OLEUM MENTHA PIPERITA.— Oil of Peppermint. Dose, 0.2 
c.c; 3 n\. 

Preparations. 

1. Aqua Menthae Piperitae. — Peppermint Water. Dose, 16 
c.c; 4 fl. dr. 

2. Spiritus Menthse Piperitae. — Spirit of Peppermint. (Es- 
sence of Peppermint.) Dose, 2 CCS. J 30 n\. 



LAVENDER. 645 

Unofficial Preparations. 

Infusum Menthae Piperitae. — Infusion of Peppermint. Dose, 
freely. 

Trochisci Menthae Piperitae (U. S. P., 1890). — Troches of 
Peppermint. Dose, freely. 

Action of Peppermint. 
Oil of peppermint has the action of volatile oils in general. 
The feeling of coolness and numbness which sometimes attends 
the external application of these agents is particularly marked 
in the case of oil of peppermint, on account of the menthol in 
its composition. Like many other volatile oils, especially those 
containing a considerable amount of terpene, it is actively 
antiseptic. 

Therapeutics of Peppermint. 

External. — Oil of peppermint is in common use as the " pep- 
permint test " for defective plumbing. The menthol in it ren- 
ders its external application of value in many cases of neural- 
gia. The surface painted over with it should be covered with 
oiled silk to prevent evaporation. Similar applications may be 
made for the relief of myalgia and various rheumatic and 
gouty pains. Peppermint water, with the addition of 4'to 8 gm. 
(1 to 2 dr.) of borax to each 500 c.c. (1 pint), is useful in 
pruritus of the genitals. 

Internal. — Peppermint is very largely employed as an efficient 
stomachic and carminative (often in association with sodium 
bicarbonate), and also as a flavoring agent. An infusion 
("peppermint tea"), generally made with about a tablespoon- 
ful of the herb to one or two cupfuls of water, is a popular 
household remedy to induce perspiration or promote diuresis in 
fevers or chills, as well as to relieve attacks of colic. For the 
latter purpose the spirit, in hot water, is more effective, and it 
is especially well suited to children. Peppermint water is in 
very general use as a component of carminative mixtures for 
infants. The inhalation of the oil, vaporized by means of hot 
water, is reported to have been of material service in a number 



I 



646 PHARMACOLOGY AND THERAPEUTICS. 

of cases of pulmonary tuberculosis. The troches are sometimes 
useful in relieving nausea, as well as flatulence and pain. 

SPEARMINT. 
MENTHA VIRIDIS.— Spearmint. Dose, 4 gm.; 60 gr. 

OLEUM MENTHA VIRIDIS.— Oil of Spearmint. Dose, 0.2 C.C.; 

3 m,. 

Preparation. 

1. Aqua Menthae Viridis.— Spearmint Water. Dose, 16 c.c; 
4 fl. dr. 

2. Spiritus Mentha Viridis. — Spirit of Spearmint. (Es- 
sence of Spearmint.) Dose, 2 C.C.; 30 nT.. 

Action of Spearmint. 
It has the same action as peppermint, but its effects are less 
pronounced. 

Therapeutics of Spearmint. 
The therapeutic applications of spearmint are the same as 
those of peppermint, but its oil is not so agreeable as oil of 
peppermint. The preparations of spearmint are in less gen- 
eral use than those of peppermint. 

ANISE AND STAR-ANISE. 

ANISTJM.— Anise. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 
OLEUM ANISL— Oil of Anise. Dose, 0.2 c.c; 3 Ifl,. 

Preparations. 

1. Aqua Anisi. — Anise Water. Dose, 16 c.c; 4 fl. dr. 

2. Spiritus Anisi. — Spirit of Anise. Dose, 4 c.c; 1 fl. dr. 

Unofficial Preparations. 
Illicium (U. S. P., 1890).— Illicium. (Star-Anise.) Dose, 0.30 
to 2.00 gm.; 5 to 30 gr. 



CORIANDER. 647 

Oleum Illicii. — Oil of Star- Anise. Dose, .06 to .30 c.c; 1 

to 5 TT\. 

Action of Anise. 
The action of oil of anise is the same as that of aromatic oils 
generally. Although anise imparts a peculiar taste to the milk 
of nursing women, it apparently does not augment the secre- 
tion, as is supposed by some. Anisic acid (which is formed 
from anethol, the main constituent of the oil, by the action of 
chromic and nitric acids) and sodium anisate are antiseptic 
and are also said to be antipyretic. 

Therapeutics of Anise. 

Anise is the pleasantest carminative for infants and young 
children, and the seeds are used in many culinary products as a 
condiment which tends to increase their digestibility. It prob- 
ably has some slight efficacy as an expectorant, and it is em- 
ployed to a considerable extent as an agreeable component of 
cough mixtures. It is also much used as a general flavoring 
agent. 

Action of Star-Anise. 

Star-anise owes its properties entirely or chiefly to its vola- 
tile oil, the action of which is the same as that of oil of anise. 

Therapeutics of Star-Anise. 
Its seeds and oil have been used externally to relieve local 
pains, such as colic, rheumatism, earache, etc., and internally in 
the treatment of flatulent colic and bronchitis. 

CORIANDER. 

CORIANDRUM.— Coriander. Dose, 0.500 gm. (500 milligm.) ; 
7y 2 gr. 

OLEUM CORIANDRL— Oil of Coriander. Dose, 0.2 c.c; 3 Vf\,. 

Action of Coriander. 

Oil of coriander has the same action as other aromatic vola- 
tile oils. 



648 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Coriander. 
Coriander is employed in confectionery and to promote the 
digestion of certain kinds of pastry. In medicine it is used 
almost entirely for flavoring purposes, for disguising the taste 
of senna and rhubarb, and for preventing the griping of these 
and other purgatives. 

FENNEL. 

FCENICULUM.— Fennel. Dose, 1 m.; 15 gr. 

OLEUM FCENICULL— Oil of Fennel. Dose, 0.2 c.c.; 3 HI. 

Preparation. 
Aqua Foeniculi. — Fennel Water. Dose, 16.0 c.c; 4 fl. dr. 

Unofficial Preparation. 
Infusum Foeniculi. — Infusion of Fennel. Dose, freely. 

Action of Fennel. 
Oil of fennel has the same action as that of anise and other 
similar oils. It has been supposed to have the effect of increas- 
ing the secretion of milk, urine, perspiration and bronchial 
mucus, and also to act as an emmenagogue. 

Therapeutics of Fennel. 
, As. one of the most grateful of the various aromatics, fennel 
is employed to quite a large extent as a stomachic and carmina- 
tive, and as a corrective against the griping effects of purga- 
tives. It is still sometimes used in hot infusion, as an adju- 
vant, in the treatment of amenorrhcea dependent on uterine con- 
gestion and for re-establishing the mammary secretion when 
suppressed. The infusion (not official, 4 gm. ; 1 dr. to 250 c.c; 
y 2 pint of water) is given as an enema to infants for the 
expulsion of flatus. 

CARAWAY. 

CARUM. — Caraway. Dose, 1 gm.; 15 gr. 

OLEUM CARL— Oil of Caraway. Dose, 0.2 c.c; 3 TTt. 



ELDER. 649 

Action of Caraway. 
The action of oil of caraway is the same as that of other 
aromatic volatile oils. 

Therapeutics of Caraway. 
Caraway is used chiefly as a flavoring agent and a carmina- 
tive for flatulent colic, especially in infants. The seeds are often 
baked in cakes, which thus receive a pleasant aromatic taste 
and have the effect of stimulating the digestive organs. 

DILL. 

Unofficial Preparation. 
Anethum.— Dill. Dose, 0.60 to 2.00 gm.; 10 to 30 gr. 

Action of Dill. 
The same as that of anise and caraway. 

Therapeutics of Dill. 
It is not much used in this country, but may be employed for 
the relief of flatulent colic and hiccough due to gastric indiges- 
tion. In England, dill water (B. P.; dill fruit, 1; water, 10; 
dose, 30 to 60 c.c. ; 1 to 2 fl. oz.) is a common carminative for 
children, and it is also sometimes given to cover the taste of 
sodium salts. 

ELDER. 
Unofficial Preparations. 
Sambucus (U. S. P., 1890). — Sambucus. (Elder.) Dose, 2 to 
4 gm.; 1/2 to 1 dr. 

Decoctum Sambuci. — Decoction of Sambucus. Dose, freely. 

Action of Sambucus. 
Elder flowers are gently stimulant and diaphoretic. The in- 
ner bark of the elder is a hydragogue cathartic and in large 
doses emetic. 

Therapeutics of Sambucus. 
The flowers are considerably used for flavoring purposes. 
Elder-flower water (B. P. — 1 in 1) makes a good vehicle for 



65O PHARMACOLOGY AND THERAPEUTICS. 

collyria and lotions. The berries are edible, and jam or con- 
serve made from them is somewhat laxative. A decoction of 
the fresh inner bark is said to be strongly diuretic and to have 
been used with good effect in acute nephritis. 

PENNYROYAL. 

HEDEOMA. — Hedeoma. (Pennyroyal.) Dose, 8 gm.; 120 gr. 
OLEUM HEDEOM^E.— Oil of Hedeoma. Dose, 0.2 c.c.; 3 m_. 

Action of Pennyroyal. 
Pennyroyal is a gentle aromatic stimulant. 

Therapeutics of Pennyroyal. 
It may be given in flatulent colic and sick stomach. The oil 
is in common use locally applied as a remedy for mosquito 
bites. 

WORMWOOD. 

Unofficial Preparations. 

Absinthium (U. S. P., 1890). — Absinthium. (Wormwood.) 
Dose, 0.50 to 2.40 gm.; 8 to 40 gr. 

Infusum Absinthii. — Infusion of Wormwood. Dose, 30 to 60 
c.c; 1 to 2 fl. oz. 

Action of Wormwood. 
In medicinal doses wormwood is a digestive stimulant. Ab- 
sinthol differs from many of the volatile oils in the profound 
effect which, when given in sufficient amount, it has upon the 
central nervous system, the result of which is seen in a marked 
increase in the reflexes. It gives rise to epileptiform convul- 
sions, and in these, other parts of the central axis are involved 
as well as the cerebrum, which is mainly responsible for them. 
It is found that the continued use of absinthe produces various 
nervous symptoms, morning nausea and vomiting, and a ten- 
dency to such epileptiform convulsions. 



CHAMOMILE. 65 I 

Therapeutics of Wormwood. 
Wormwood is used in an infusion as an aromatic tonic in 
atony of the stomach or intestines. The volatile oil has been 
employed as a local anaesthetic for rheumatic and other pains 
and internally in the form of a liqueur, as a narcotic stimulant 
in cerebral exhaustion. 

CHAMOMILE. 
ANTHBMIS. — Anthemis. (Chamomile.) Dose, 2 gm.; 30 gr. 

Unofficial Preparations. 

Infusum Anthemidis. — Infusion of Anthemis. Dose, 30 to 
60 c.c; 1 to 2 fl. oz.; as an emetic, 150 to 300 c.c; 5 to 10 fl. oz. 

Oleum Anthemidis. — Oil of Anthemis. Dose, .06 to .25 c.c; 
1 to 4 TTt. 

Action of Chamomile. 

Chamomile has the general action of the aromatic volatile 
oils. Its oil is said to have the power of reducing reflex excita- 
bility in frogs, even after its excitation by strychnine or 
brucine. 

Therapeutics of Chamomile. 

External. — A poultice made with chamomile flowers is a 
popular domestic remedy, but it has no special advantages over 
other kinds of cataplasms. The oil, on account of its sedative 
action, has been recommended as a serviceable addition to fatty 
preparations for various inflammations of the skin. Combined 
with other remedies in ointments, it may be used in erysipelas, 
erythema, acute eczema, seborrhcea, etc. 

Internal. — Chamomile is more or less used as a stomachic 
and carminative. The infusion acts as an emetic when given 
in doses of considerable size. In smaller doses it is aro- 
matic and carminative, and favors diuresis and the action of the 
skin. It is a popular household remedy for colds, dyspepsia 
and intestinal disorders. The oil has some effect in checking 
reflex cough, and may prove useful in spasmodic asthma. It 
is believed that it should be of service in poisoning by strych- 



652 PHARMACOLOGY AND THERAPEUTICS. 

nine, on account of its depressant action upon the reflex excita- 
bility of the spinal cord. 

GERMAN CHAMOMILE. 

MATRICARIA.— Matricaria. (German Chamomile.) Dose, 16 
gm.; 240 gr. 

Action and Therapeutics of Matricaria. 
These are identical with those of chamomile. 

GARLIC. 

Unofficial Preparations. 

Allium (U. S. P., 1890). — Garlic. Dose, 1.0 to 2.0 gm.; 15 to 
30 gr. 

Syrupus Allii. — Syrup of Garlic. Dose, 4.0 to 16.0 c.c; 1 to 
4 fl. dr. 

Action of Garlic. 
The effects of garlic are those of a general stimulant, quick- 
ening the circulation, exciting the nervous system, and promot- 
ing expectoration. 

Therapeutics of Garlic. 
It is beneficial in impaired digestion and in chronic affections 
of the respiratory organs in which symptoms of inflammation 
have subsided and a relaxed state of the vessels remains. 

SAGE. 

SALVIA.— Salvia. (Sage.) Dose, 2 gm.; 30 gr. 

Unofficial Preparation. 
Infusum Salviae. — Infusion of Salvia. Dose, 30 to 60 C.C.; 
1 to 2 fl. oz. 

Action of Sage. 
Sage has the action of volatile oils generally and is also 
astringent in consequence of its tannic acid. The oil has been 
shown to occasion epileptiform convulsions in dogs. 



ROSE. "653 

Therapeutics of Sage. 
While used chiefly as a condiment, it is said to be beneficial 
in checking the perspiration of hectic fever. Infusion of sage 
(1-4) is employed as a gargle and an astringent wash for the 
mouth or nasal passages. The compound sage-gargle is made 
as follows: Sage, 30; alum, 15; clarified honey, 60; boiling 
water, 500. Sage is sometimes combined with other remedies 
as an injection for urethritis or cystitis. 

ROSE. 
ROSA GALLICA.— Red Rose. 

Preparations. 

1. Confectio Rosae. — Confection of Rose. 

2. Fluidextractum Rosse. — Fluidextract of Rose. Dose, 2 
c.c; 30 TTj.. 

3. Mel Rosae. — Honey of Rose. Dose, 4 C.C.; 1 fl. dr. 

4. Syrupus Rosas.— Syrup of Rose. 

OLEUM ROS^:.— Oil of Rose. (Attar of Rose.) 

Preparations. 

1. Aqua Rosae Fortior. — Stronger Rose Water. Dose, 8 c.c; 
2 fl. dr. 

2. Aqua Rosae. — Rose Water. Dose, 16 c.c; 4 fl. dr. 

3. Unguentum Aquae Rosae. — Ointment of Rose Water. 

Unofficial Preparation. 
Rosa Centifolia (U. S. P., 1890).— Pale Rose. 

Action of Rose. 
Preparations of rose are somewhat astringent, but have not 
much other action. 

Therapeutics of Rose. 

The confection is a good base for pills, and the water an 

agreeable excipient for collyria, lotions and urethral injections. 

The ointment of rose water is a favorite soothing application 

for the skin, The infusion (B. P., not official : Dried petals, 2; 



654' PHARMACOLOGY AND THERAPEUTICS. 

diluted sulphuric acid, i; water, 80), which is slightly astrin- 
gent, constitutes an acceptable gargle and wash for inflamed or 
ulcerated conditions of the throat and mouth. Given inter- 
nally it offers a pleasant method of administering sulphuric 
acid. 

ORANGE. 

AURANTII AMARI CORTEX.— Bitter Orange Peel. Dose, 1 
gm.; 15 gr. 

Preparations. 

1. Fluidextractum Aurantii Amari. — Fluidextract of Bitter 
Orange Peel. Dose, 1 c.c; 15 TT\. 

2. Tinctura Aurantii Amari. — Tincture of Bitter Orange 
Peel. Dose, 4 c.c; 1 fl. dr. 

Unofficial Preparations. 
Tinctura Aurantii Recentis Corticis. — Tincture of Fresh 
Orange Peel. Dose, 4 c.c.; 1 fl. dr. 

AURANTII DULCIS CORTEX.— Sweet Orange Peel. Dose, 1 
gm.; 15 gr. 

Preparation. 
Tinctura Aurantii Dulcis. — Tincture of Sweet Orange Peel. 
Dose, 4 c.c; 1 fl. dr. 

Syrupus Aurantii. — Syrup of Orange. 

OLEUM AURANTII CORTICIS.— Oil of Orange Peel. Dose, 0.2 
c.c; 3 TTt. 

Preparations. 

1. Spiritus Aurantii Compositus. — Compound Spirit of 
Orange. 

2. Elixir Aromaticum. — Aromatic Elixir. 

3. Elixir Adjuvans. — Adjuvant Elixir. 

Unofficial Preparation. 
Spiritus Aurantii (U. S. P., 1890). — Spirit of Orange. Dose, 
2 c.c; 30 TTL- 

Preparations of the Volatile Oil of Fresh Orange Flowers. 
Unofficial Preparation. 
1. Aqua Aurantii Florum Fortior. — Stronger Orange Flower 
Water. (Triple Orange Flower Water.) Dose, 8 C.C.; 2 fl. dr. 



LEMON. 655 

2. Aqua Aurantii Florum.— Orange Flower Water. Dose, 16 
c.c; 4 fl. dr. 

3. Syrupus Aurantii Florum. — Syrup of Orange Flowers. 

Unofficial Preparation. 
Oleum Aurantii Florum (U. S. P., 1890). — Oil of Orange 
Flowers. (Oil of Neroli.) 

Action of Orange. 
Orange is slightly bitter and aromatic, stomachic and tonic. 
Its oil has the action of other volatile oils. In large amounts 
it is a gastro-intestinal irritant and may give rise to convul- 
sions. Persons much exposed to its fumes are liable to skin 
eruptions and various nervous disorders. 

Therapeutics of Orange. 
The preparations of the orange are used extensively for fla- 
voring purposes. The aromatic and adjuvant elixirs are excel- 
lent flavoring agents and vehicles for liquid medicines. 

LEMON. 
LIMONIS CORTEX.— Lemon Peel. 

Preparation. 
Tinctura Limonis Corticis. — Tincture of Lemon Peel. 
OLEUM LIMONIS.— Oil of Lemon. Dose, 0.2 c.c.; 3 m.. 

Unofficial Preparation. 
Spiritus Limonis (U. S. P., 1890). — Spirit of Lemon. (Es- 
sence of Lemon.) Dose, 2 c.c; 30 TT\. 

LIMONIS SUCCTJS.— Lemon Juice. Dose, 30 c.c; 1 fl. oz. 

Action of Lemon. 
The same as that of orange. 

Therapeutics of Lemon. 
The preparations of the lemon, like those of the orange, are 
employed as flavoring agents. The oil may be applied exter- 
nally as a rubefacient, but is seldom used for this purpose. 



656 PHARMACOLOGY AND THERAPEUTICS. 

Action of Lemon Juice. 

Lemon juice, which contains a considerable amount of free 
citric acid, has the same action as this acid (see pp. 331 and 
342). 

Therapeutics of Lemon Juice. 

Lemon juice, in the form of lemonade and various effer- 
vescing mixtures, relieves thirst and makes an otherwise re- 
freshing beverage. Hot lemonade, to which whiskey or gin 
is often added, is useful as a diaphoretic in commencing colds. 
Lemon juice is also largely employed for flavoring flaxseed tea 
and the mildly nutritive drinks given in fevers. Its most im- 
portant medicinal use is in the prophylaxis and treatment of 
scurvy, in which lemon and lime juice may almost be consid- 
ered specifics. Orange juice is also efficient. The beneficial 
effect appears to be due, not to the citric acid, but to some 
unknown property of the fruit juices. 90 to 120 c.c. (3 to 4 
fl. oz.) should be taken daily. A somewhat larger amount is 
said to have afforded marked relief in certain cases of rheu- 
matism, both chronic and acute. Lemon juice is one of the 
popular remedies in this disease, though not very much reliance 
is probably to be placed upon it. Its local application is effi- 
cient in arresting post-partum haemorrhage. For this purpose 
a gashed lemon should be carried up into .the uterine cavity and 
squeezed, when vigorous contractions will be excited in the 
same manner as by squeezing in the uterus a rag saturated with 
vinegar. Lemon juice is applied to the integument to relieve 
pruritus and to remove sunburn, freckles, moth-spots, and ink- 
stains. For sunburn an excellent lotion is made of equal parts 
of lemon juice and glycerin, with the addition of some bismuth 
subnitrate. 

PEPPER. 

PIPER.— Pepper. (Black Pepper.) Dose, 0.500 gm. (500 
milligm.); 7V 2 gr. 

Preparation. 
Oleoresina Piperis. — Oleoresin of Pepper. Dose, 0.030 gm. 
(30 milligm.) ; y 2 gr. 

PIPERINA.—Piperine. Dose, 0.200 gm. (200 milligm.) ; 3 gr, 



PYRETHRUM. 657 

Action of Pepper. 
By reason of its volatile oil, pepper has much the same action 
as cloves. In the course of its excretion it acts as a disinfect- 
ant and stimulant to the genito-urinary tract, and it is reputed 
to be feebly antiperiodic and antipyretic. 

Therapeutics of Pepper. 
In the form of ointment pepper is efficient in tinea capitis. 
It is occasionally employed for counter-irritation, as a substi- 
tute for mustard, and, in washes and gargles, for relaxed con- 
ditions of the gums and throat. It is universally used as a 
condiment, and its chief medical application is to stimulate the 
stomach and correct flatulence. Pepper lozenges, or the con- 
fection (B. P., Pepper, 2; carroway, 3; honey, 15. Synonym, 
Ward's paste), are sometimes given for the relief of ulcers of 
the rectum, anal fistulae and fissures, haemorrhoids, gleet and 
leucorrhcea. In malarial fevers the oleoresins of both black 
pepper and capsicum have sometimes proved of service as adju- 
vants to other remedies. Piperine has been used in cholera as 
a stimulant, local and general, and in low conditions of the 
system from various causes other than gastro-intestinal inflam- 
mation. 

PYRETHRUM. 

PYRETHRUM.— Pyrethrum. (Pellitory.) Dose, 2 gm.; 30 gr. 

Preparation. 
Tinctura Pyrethri. — Tincture of Pyrethrum. 

Action of Pyrethrum. 
Pyrethrum is an irritant sialogogue. When chewed it has a 
prickly, pungent effect upon the mouth, tongue and fauces, and 
excites a free secretion of saliva and buccal mucus. It is a 
rubefacient and when inhaled into the nostrils causes sneezing. 
Internally it has the characteristic action of the volatile oils, 
and when taken in considerable quantities may cause gastro- 
enteritis, with bloody stools, and more or less stupor. In a 
43 



658 PHARMACOLOGY AND THERAPEUTICS. 

child 2^/2 years old tetanoid convulsions were also produced 
by it. 

Therapeutics of' Pyrethrum. 
It is chewed as a masticatory in paralysis of the tongue, and 
when in other conditions an increased flow of saliva is desired. 
In neuralgic, rheumatic, or other painful affections of the 
tongue or teeth it may also be chewed or held in the mouth, as 
the burning sensation to which it at first gives use is followed 
by one of numbness; the stimulation of the nerves of the parts 
which it causes being succeeded by depression and a blunted 
sensibility. For the aching of a carious tooth a few drops of 
the tincture may be introduced into the cavity on cotton wool. 
Properly diluted, it makes an efficient lotion for scorbutic and 
other forms of sore mouth and gargle for relaxed uvula. Pyre- 
thrum is sometimes used as an ingredient of tooth-powders. Its 
sialogogue action has been found of service in the removal of 
iodine from the system in cases of chronic poisoning by that 
drug. The powder has been recommended as a sternutatory in 
chronic catarrh of the frontal sinuses. Persian insect powder 
consists of the flowers of the chrysanthemum (or pyrethrum) 
roseum, a variety of pellitory growing in Asia. 

CAPSICUM. 

CAPSICUM. — Capsicum. (Cayenne Pepper. Guinea Pepper.) 
Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Fluidextractum Capsici. — Fluidextract of Capsicum. Dose, 
0.05 c.c; 1 TTL. 

2. Oleoresina Capsici. — Oleoresin of Capsicum. Dose, 0.030 
gm. (30 milligm.) ; y 2 gr. 

3. Tinctura Capsici. — Tincture of Capsicum. Dose, 0.5 c.c; 
8 rc\,. 

4. Emplastrum Capsici. — Capsicum Plaster. 

5. Pilulae Podophylli, Belladonnae et Capsici. — Pills of 
Podophyllum, Belladonna and Capsicum. Dose, 1 pill. 



CAPSICUM. 659 

Action of Capsicum. 
Although it contains no volatile oil, the action of capsicum 
is like that of the volatile oils generally. It is a powerful local 
irritant, its oleoresin when applied to the skin producing in a 
short time intense pain and redness, and eventually destroying 
the cuticle. In the alimentary canal it acts in a similar way. 
In the stomach, in small doses, it occasions a feeling of warmth, 
excites hyperemia, and stimulates the muscular coat and the 
secretions, while large doses give rise to gastro-enteritis, which 
after a time is accompanied by strangury and other evidences 
of irritation of the genito-urinary tract. Aphrodisiac effects 
have sometimes been noted. It is chiefly eliminated by the 
kidneys, and moderate amounts increase the flow of urine. It 
is a powerful stimulant to the heart, and thus increases the 
strength and frequency of the pulse. 

Therapeutics of Capsicum; 
External. — The tincture of capsicum, like that of cantharides, 
has been used to stimulate the scalp in the various forms of 
alopecia, and it is frequently employed as a domestic remedy 
for toothache and chilblains. The diluted tincture, or an infu- 
sion, makes a serviceable gargle in scarlet fever and for relaxed 
uvula, pharyngitis, and other throat affections. In tonsillitis 
the tincture, with an equal quantity of glycerin, may be topically 
applied by means of a swab. The tincture is used in making 
up rubefacient liniments, and capsicum ointment (B. P.) is also 
employed as a counter-irritant (Capsicum, 6; spermaceti, 3; 
olive oil, 22). This resembles Smedley's paste. A strong tinc- 
ture of capsicum-pods, mixed with an equal quantity of muci- 
lage of gum arabic, has been recommended in chilblains (when 
the surface is unbroken), discolored bruises, chronic rheumatic 
pains, etc. The preparation is brushed two or three times upon 
tissue paper, which is then applied to the affected surface. 
Capsicum plaster is quite extensively used as a rubefacient and 
counter-irritant. 



660 PHARMACOLOGY AND THERAPEUTICS. 

Internal. — Capsicum is much used as a condiment. In medi- 
cine it is an excellent remedy for flatulent colic and for cases 
of atony of the stomach due to general debility, errors in diet, 
and subacute and chronic alcoholism. In acute alcoholism it 
should be given with caution, if at all, as there is likely to be 
present more or less gastric irritation, which may be aggra- 
vated by the drug. After a few days it may usually be given 
with advantage, as it serves to increase the appetite and diges- 
tive power, and by its stimulating effect and the hot sensation 
to which it gives rise it often satisfies, at least to some degree, 
the craving for liquor. In these cases the tincture may be 
administered every four or five hours in doses of .30 to .60 c.c. 
(5 to 10 ni), or the oleoresin in a pill containing .03 to .06 gm. 
(^ to 1 gr.). In delirium tremens capsicum is often valuable 
in quieting restlessness and inducing sleep. It should here be 
given in a dose of about 2 gm. (30 gr.), which may be admin- 
istered in an animal broth or made into a bolus with syrup or 
honey. Tincture of capsicum has been resorted to in the treat- 
ment of the opium, as well as the alcohol, habit. Capsicum 
tends to check albuminuria, and is therefore sometimes of ser- 
vice in chronic parenchymatous nephritis. It may also prove 
beneficial in functional torpidity of the kidney, but it is never 
admissible in acute renal inflammation. In chronic pyelitis, 
chronic cystitis, and prostatorrhcea it is of some value, though 
not as efficient as cubeb. Good results may often be obtained 
from it in functional impotence and in spermatorrhoea from 
deficient tone. The oleoresin is the best preparation for use in 
these genito-urinary affections. Capsicum has been given as 
a diffusible stimulant in low fevers, but is more useful in the 
anorexia and impaired digestion of convalescence. 

GINGER. 
ZINGIBER.— Ginger. Dose, 1 gm.; 15 gr. 

Preparations. 
1. Fluidextractum Zingifoeris. — Fluidextract of Ginger. 
Dose, 1 c.c; 15 IT],. 



CARDAMOM. - 66 I 

2. Oleoresina Zingiberis. — Oleoresin of Ginger. Dose, 0.030 
gm. (30 milligm.) ; y 2 gr. 

3. Tinctura Zingiberis. — Tincture of Ginger. Dose, 2 c.c; 
30 tti. 

4. Syrupus Zingiberis. — Syrup of Ginger. Dose, 16 c.c; 
4 fl. dr. 

5. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15 
gr. 

6. Fluidextractum Aromaticum. — Aromatic Fluidextract. 
Dose, 1 c.c; 15 1TI. 

Unofficial Preparation. 
Trochisci Zingiberis (U. S. P., 1890). — Troches of Ginger. 
Dose, freely. 

Action of Ginger. 
Ginger has the same action as that of other substances con- 
taining aromatic volatile oils. 

Therapeutics of Ginger. 
It is much used as a stomachic, carminative, and flavoring 
agent. It is a favorite domestic remedy for colic, and, given 
in hot water, is also frequently employed as a sudorific and 
stimulant in the pain due to acute suppression of the menses. 
It is administered in association with various other remedies 
in the treatment of atonic dyspepsia, especially in elderly per- 
sons, and is useful in flatulence and some forms of diarrhoea. 
It may be given with salines to disguise their taste, and the 
oleoresin is a useful addition to purgative pills to prevent 
griping. 

CARDAMOM. 

CARDAMOMTJM. — Cardamom. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Tinctura Cardamomi. — Tincture of Cardamom. Dose, 4 
c.c; 1 fl. dr. 

2. Tinctura Cardamomi Composita.— Compound Tincture of 
Cardamom. Dose, 4 c.c.; 1 fl. dr. 



662 PHARMACOLOGY AND THERAPEUTICS. 

3. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15 
gr. 

4. Fluidextractum Aromaticum. — Aromatic Fluidextract. 
Dose, 1 c.c; 15 n\,. 

Action of Cardamom. 
Cardamom is carminative and stomachic, acting, by reason 
of its volatile oil, like cloves or pepper. 

Therapeutics of Cardamom. 
As the compound tincture has a bright red color, due to its 
cochineal, and an agreeable aromatic taste, it is frequently 
employed as a coloring and flavoring agent. It is a customary 
addition to mixtures given for the relief of flatulent colic, and, 
mixed simply with sweetened hot water, is also a favorite rem- 
edy for such affections. The Tinctura Carminativa of the 
British Pharmaceutical Conference is likewise an excellent 
flavoring carminative. (Cardamom, 6; tincture of ginger, 6; 
oil of cinnamon, oil of cloves, oil of caraway, of each, i ; recti- 
fied spirit to 96. Dose, .12 to .60 c.c; 2 to 10 HI.) Cardamom 
makes one of the best flavoring additions to saline solutions or 
mixtures, and when combined with purgatives is very efficient 
in correcting flatulence and griping. 

PEPSIN. 

PEPSINXJM.— Pepsin. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparation. 
Pepsinum Saccharatum (U. S. P., 1890). — Saccharated Pep- 
sin. Dose, 1 gm.; 15 gr. 

Action of Pepsin. 
The only action of pepsin, which is a normal constituent of 
the gastric juice, appears to be on the digestive system. In the 
presence of hydrochloric acid it digests the proteid elements of 
the food, converting them into albumoses, and finally into pep- 
tones. In alkaline solution it is not only inert, but is rapidly 
decomposed. 



PEPSIN. 663 

Therapeutics of Pepsin. 
Pepsin is usually prescribed on the hypothesis that in cer- 
tain conditions the stomach does not secrete a sufficient quan- 
tity of it. It has been questioned, however, whether this is true 
in even a small proportion of the cases in which this ferment 
is given, since the gastric juice is found to be almost always 
capable of digesting proteids if it is acid in reaction. In a 
number of forms of dyspepsia, while the acid secretion is defi- 
cient, pepsin is generally present in quantity, since it will digest 
proteids outside the body as soon as it becomes acid in reaction. 
Consequently, pepsin would seem to be indicated only in those 
instances in which the gastric contents acidulated with hydro- 
chloric acid fail to perform their digestive work. Pepsin may 
be used as an aid to stomach digestion in those in whom from 
old age, continued illness, or other cause, the secretion of gas- 
tric juice is inadequate. It has been found to be more certain 
in its effects in the impaired digestion of infants than of adults, 
and this has been attributed by some, who hold that the ordi- 
nary quantities given to adults are entirely too small, to the 
fact that to young children it is administered in proportionately 
much larger doses. When it is prescribed together with alka- 
line carbonates, any effects produced are due entirely to the lat- 
ter, the pepsin being decomposed in the presence of alkalies. 
It is naturally of no service in promoting the digestion of fatty 
or carbohydrate foods. Unless obtained from an absolutely 
reliable source, pepsin should be tested before giving it to a 
patient, as many of the specimens sold are quite inert. It 
should be administered, in a powder, pill or tablet, immediately 
after meals, and followed in about half an hour with a suitable 
dose of hydrochloric acid. One of the applications now made 
of pepsin is the predigestion by it of albuminous food, which 
may then be given either by the mouth or the rectum, and as 
morbid processes which interfere with digestion may be going 
on in the stomach, this method is not infrequently preferable to 
using the ferment in the ordinary way. As a rule, however, 
pancreatin is found to be of more service for purposes of pre- 






664 PHARMACOLOGY AND THERAPEUTICS. 

digestion than pepsin. The rectum, as is well known, has only- 
very feeble digestive powers, and consequently nutrient ene- 
mata or suppositories should always be predigested. In the use 
of predigested foods, either by the mouth or rectum, much dis- 
cretion should be employed, and except in case of absolute 
necessity the method should not be maintained for a very long 
period continuously, as there is some danger that the digestive 
functions of the stomach, from lack of use, may become inca- 
pable of action. 

Meat may be peptonized in the following manner: Reduce 
to a fine pulp 450 gm. (1 pound) of lean meat, add six times 
its weight of water containing 0.2 per cent, of hydrochloric 
acid and 8 gm. (120 gr.) of pepsin, and digest at 48 C. (120 
F.) in a porcelain digester for five or six hours, with frequent 
stirring; neutralize with sodium carbonate, boil and filter; 
evaporate the filtrate on a water-bath until it is of the con- 
sistency of a soft extract. Peptonized meat suppositories are 
often very serviceable. To make one suppository 2 gm. (30 
gr.) of the above extract is mixed with 2.40 gm. (40 gr.) of 
oil of theobroma, and shaped in a conical mould. 

PANCREATIN. 

PANCREATINUM.— Pancreatin. (Zymine.) Dose, 0.500 gm. (500 
milligm.); 7y 2 gr. 

Unofficial Preparation. 
Trypsinum. — Trypsin. 

Action of Pancreatin. 
Pancreatin, in the presence of alkalies, has the power of 
digesting albuminoids and all proteid substances, which are 
changed to peptones, of converting starch into sugar, and, when 
not over twenty-four hours old, of emulsionizing fats. It co- 
agulates and then peptonizes milk, and will also peptonize gruel, 
oysters and many other articles of diet. It is incapable of act- 
ing in an acid medium, or in a temperature above 6o° C. 
(140 R). 



VALERIAN. 665 

Therapeutics of Pancreatin. 

It is used as an artificial agent to assist the digestion of in- 
valids and of old persons, or those prostrated by fever or ex- 
haustion. Also by means of it food may be partially or 
wholly digested previous to administration. It should be used 
in combination with an alkali, as sodium bicarbonate, in the 
proportion of 1 to 4. Nutritive enemata should be thoroughly 
pancreatized. If pancreatin be administered two hours after 
meals it will assist intestinal digestion, and it is especially indi- 
cated in those conditions in which starch and fat are imper- 
fectly digested. It should be preceded by full doses of sodium 
bicarbonate, or other alkali, to insure an alkaline reaction in 
the contents of the stomach. It is sometimes of service in the 
vomiting of pregnancy or of hysteria. In diphtheria a spray 
of trypsin (the proteolytic ferment of pancreatin) or of pan- 
creatin solution has been used with considerable success for 
the purpose of dissolving the false membrane and promoting 
its expulsion. Pancreatin has also been employed in the blad- 
der, like pepsin, to dissolve blood-clots resulting from haemor- 
rhage. 

VALERIAN. 

VALERIANA.— Valerian. Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Valerianae. — Fluidextract of Valerian. 
Dose, 2 c.c; 30 n\.. 

2. Tinctura Valerianae. — Tincture of Valerian. Dose, 4 c.c; 
1 fl. dr. 

3. Tinctura Valerianae Ammoniata. — Ammoniated Tincture 
of Valerian. Dose, 2 c.c; 30 m,. 

AMMONII VALERAS.— Ammonium Valerate. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 

ZINCI VALERAS.— Zinc Valerate. Dose, 0.125 gm. (125 mil- 
ligm.) ; 2 gr. 

Unofficial Preparations of Valerian. 
Ferri Valerianas (U. S. P., 1890). — Ferric Valerianate. 
(Ferric Valerate.) Dose, 0.05 to 0.15 gm.; 1 to 3 gr. 



666 PHARMACOLOGY AND THERAPEUTICS. 

Quininse Valerianas (U. S. P., 1890). — Quinine Valerianate. 
(Quinine Valerate.) Dose, 0.05 to 2.00 gm.; 1 to 30 gr. 

Sodii Valerias. — Sodium Valerate. Dose, 0.05 to .30 gm.; 1 
to 5 gr. 

Oleum Valerianae. — Oil of Valerian. Dose, .12 to .30 c.c; 
2 to 5 HI. 

Action of Valerian and the Valerates. 
Neither valerianic acid nor ammonium, ferric, sodium, qui- 
nine or zinc valerates are known to have any physiological 
action, although their extensive use warrants the belief that 
they are valuable remedies. Valerian itself acts in virtue of 
its volatile oil, which has the same properties as other volatile 
oils. Valerian is therefore an irritant when applied externally, 
causing redness, itching and warmth by reason of the local 
dilatation of vessels which it induces. Internally it stimulates 
the mouth (leading to a reflex secretion of saliva) and the 
gastro-intestinal tract. It causes increased appetite and in the 
stomach a sense of warmth and comfort, with reflex stimula- 
tion of the heart and nervous system. The slight irritation 
produces hyperemia of the mucous membrane, with some in- 
crease of secretion, and the movements of the stomach are 
accelerated. Similar effects are observed in the intestine. 
While nervous effects are produced reflexly by the local action, 
sufficient doses affect the central nervous system independently 
of such local action. There is a preliminary stimulation fol- 
lowed by a depression of the nerve-cells, and the higher divi- 
sions of the central axis are more markedly acted upon than 
the lower. Excretion takes place principally by the lungs and 
kidneys, and in the course of this action some irritation and 
increased secretion may be induced in these organs. The heart 
is stimulated indirectly, but does not seem to be affected except 
in this indirect manner. It has been found that in cases of 
poisoning by the volatile oil the collapse and shock may alter 
the cardiac contractions, but direct effects on the cardiac mus- 
cle, it is stated, have not been shown to be produced, unless 
when enormous quantities are injected intravenously. Under 



CYPRIPEDIUM. 66? 

large doses by the mouth nausea, hiccough, eructations of the 
drug, vomiting and diarrhoea may be caused. 

Therapeutics of Valerian and the Valerates. 
Valerian in various forms is much used as a carminative for 
the relief of flatulence, especially in hysterical conditions. Any 
feeling of fullness after meals is removed, and this is often 
accompanied by the eructation of quantities of gas. Though 
the oil is not official, it is more efficient as a carminative than 
the valerates. It is most conveniently administered suspended 
in mucilage with cinnamon water. The tincture and fluid- 
extract also usually promptly relieve the flatulence of the 
hysterical and hypochondriacal. Preparations of valerian are 
likewise serviceable as reflex stimulants in syncope, palpi- 
tation, etc., and their chief therapeutic use is in the treat- 
ment of nervousness, hysteria and hysterical disorders gen- 
erally. In these ammonium valerate is preferred by many. 
In neuralgic conditions they sometimes prove of value, ai d 
again fail to give relief. As a rule, the best preparation here 
is zinc valerate, which has also been employed with some suc- 
cess in nervous affections such as chorea and epilepsy. In 
both forms of diabetes the fluidextract has been used tempor- 
arily with advantage. It serves to diminish the amount of 
urinary water, and in the saccharine variety to lessen the ex- 
cretion of sugar. It has no curative effect, however, for as 
soon as the remedy is discontinued all benefit from it ceases. 

CYPRIPEDIUM. 

CYPRIPEDIUM.— Cypripedium. (Ladies' Slipper.) Dose, 1 gm.; 
15 gr. 

Preparation. 
Fluidextractum Cypripedii. — Fluidextract of Cypripedium. 
Dose, 1 c.c; 15 TTt. 

Action of Cypripedium. 
Cypripedium is a gentle, nervous stimulant, resembling vale- 
rian in its action. 



668 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Cypripedium. 
It has been used for nervous diseases, epilepsy, hypochon- 
driasis and neuralgia, but is not a very reliable remedy. 

ASAFETIDA. 
ASAFCETIDA.— Asafetida. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparations. 

1. Emulsum Asafoetidas. — Emulsion of Asafetida. (Mistura 
Asafoetidae. Milk of Asafetida.) Dose, 16 C.C.; 4 fl. dr. 

2. Pilulae Asafoetidae. — Pills of Asafetida. Dose, 2 pills. 

3. Tinctura Asafoetidae. — Tincture of Asafetida. Dose, 1 
c.c; 15 nr. 

Unofficial Preparation. 
Pilulae Aloes et Asafoetidae. — Pills of Aloes and Asafetida. 
Dose, 1 to 5 pills. 

Action of Asafetida. 
Owing to its containing allyl sulphide, asafetida is extremely 
unpleasant to the taste. Its action is due entirely to its vola- 
tile oil, the external and internal effects of which are those of 
the volatile oils in general. On the intestine it has a specially 
marked stimulant action, expelling flatus and producing an 
efficient carminative effect. Large doses may cause nausea and 
vomiting, though the action of the drug varies greatly in dif- 
ferent individuals. A series of experiments showed that in a 
number of persons headache and giddiness, with some aphro- 
disiac effect, were produced by 1.20 gm. (20 gr.), while others 
took as much as 15 gm. ( l / 2 oz.) with no other result than 
offensive eructations and foul-smelling faeces. It often has a 
powerful stimulant and antispasmodic effect upon the nervous 
system, and there is reason to believe that in hysterical sub- 
jects this is in part at least due to the mental influence result- 
ing from the odor and taste of the drug. In some women an 
emmenagogue effect has been noticed from it. It is excreted 
by the lungs, skin and kidneys, and is found to act like other 
volatile oils in increasing and disinfecting the secretions. 



asafetida. 669 

Therapeutics of Asafetida. 
Extraordinary as this may seem, asafetida is used in India 
as a condiment, but it is a fact also that valerian was formerly 
employed in England as a perfume. Were it not for its un- 
pleasant characteristics, and especially the extremely disagree- 
able eructations to which it gives rise, asafetida might prove 
very useful as a stomachic tonic in atonic dyspepsia accom- 
panied by torpor of the bowel. It is contained in small amount 
in some of the popular sauces. The emulsion was long held 
in high repute in the flatulent colic of infants, and is still used 
to some extent, though most practitioners prefer to give reme- 
dies less obnoxious to the attendants, if not to the little patients 
themselves. Asafetida is especially serviceable in the flatu- 
lence of neurotic subjects, expelling the flatus, promoting intes- 
tinal secretion and digestion, and relaxing the bowels; and it 
is commonly very well borne by this class of individuals. The 
pill of aloes and asafetida is a favorite form of administering 
the drug, particularly when there is constipation associated with 
amenorrhcea, and an asafetida enema (1 to 64 of water) is also 
used to relieve flatus. Partly on account of its reflex stimulat- 
ing effect, and partly on account of the moral effect of its 
offensive odor and taste, this remedy is not infrequently em- 
ployed to control hysterical, emotional and other mental dis- 
turbances, and for this purpose it is sometimes combined with 
valerian. Although asafetida, in the course of its excretion, 
would serve a useful purpose in disinfecting the urine and the 
expectoration, its disagreeableness ordinarily prevents its use 
for these purposes. Still, it is occasionally employed in sub- 
acute bronchitis and bronchorrhcea (especially in old people), 
the cough succeeding the paroxysmal stage of pertussis (which 
is often maintained by habit), and the sympathetic cough of 
mothers whose children are suffering from whooping-cough ; 
all of which conditions are found to be greatly benefited by it. 
This remedy is of service in the convulsions of children from 
reflex irritation, though it is useless in those depending upon 
cerebral or renal disease ; and may also be given with advantage 



67O PHARMACOLOGY AND THERAPEUTICS. 

in chorea, particularly in young girls about the period of 
puberty and when the affection is associated with menstrual 
difficulty. The chronic scaly eruptions (eczema, etc.), espe- 
cially when the skin is dry and harsh, are said to be much im- 
proved by the persistent use of the drug, but few patients, it 
may well be imagined, would be willing to submit to such a 
course of treatment. One of the ways of treating cases of 
malingering is to make the patient take, three times a day, an 
effervescing draught containing a few drops of the tinctures 
of asafetida and valerian; the effervescence causing the un- 
pleasant taste of the medicines to recur in the mouth for some 
time after they have been swallowed. 

AMMONIAC. 

Unofficial Preparations. 

Ammoniacum (U. S. P., 1890). — Ammoniac. Dose, 0.30 to 
2 gm.; 5 to 30 gr. 

Emplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890). 
— Ammoniac Plaster with Mercury. 

Emulsum Ammoniaci. — Emulsion of Ammoniac (U. S. P., 
1890). — Dose, 15 to 30 c.c; y 2 t0 1 fl « oz - 

Action of Ammoniac. 

Externally and internally the action of ammoniac is that of 
volatile oils. On the skin its irritant effect, which is usually 
mild, sometimes gives rise to a papular eruption. It is a stimu- 
lating expectorant and a laxative. Its action is very similar 
to that of asafetida, but while the drug is free from the objec- 
tionable features of the latter, its effects are considerably less 
powerful. 

Therapeutics of Ammoniac. 

The plaster is employed as a stimulant alterative and resol- 
vent in glandular enlargements and indolent swellings, espe- 
cially of the joints and periosteum, and is sometimes useful for 
small patches of very chronic skin diseases. The principal use 
of ammoniac internally is as an expectorant. Being excreted 



MYRRH. 67I 

by the bronchial mucous membrane, it increases and disinfects 
the secretion of the latter, and this makes it a useful remedy in 
chronic bronchitis with offensive expectoration. It is largely 
employed for old people, in whom the bronchitis is often accom- 
panied by emphysema, and its beneficial effect is increased by 
combining ammonium carbonate or chloride with it. 

GALBANUM. 

Unofficial Preparation. 
Galbanum. — Galbanum. Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

Action of Galbanum. 
It is stimulant, expectorant and antispasmodic, like other sub- 
stances containing a volatile oil. Its effects, in general, are 
similar to those of asafetida and ammoniacum, with one or the 
other of which it has usually been prescribed. Applied to the 
cutaneous surface, it occasions a papular eruption, and, if the 
true skin is exposed, causes it to ulcerate. 

Therapeutics of Galbanum. 

It has been used as a carminative, expectorant and emmena- 
gogue and as an alterant in chronic rheumatism. At the pres- 
ent time it is very rarely employed internally, its principal 
use being as an ingredient of stimulating or resolvent plasters 
for indolent swellings. The following is a good formula for 
such a plaster : Galbanum, 1 ; ammoniacum, 1 ; yellow wax, 1 ; 
lead plaster, 8. 

MYRRH. 

MYRRHA.— Myrrh. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. 

Preparations. 

1. Tinctura Myrrhae. — Tincture of Myrrh. Dose, 1 c.c; 

15 TTL- 

2. Tinctura Aloes et Myrrhae. — Tincture of Aloes and 
Myrrh. Dose, 2 C.C.; 30 TTt. 



672 PHARMACOLOGY AND THERAPEUTICS. 

3. Pilulae Aloes et Myrrhae. — Pills of Aloes and Myrrh. 
Dose, 2 pills. 

4. Mistura Ferri Composita. — Compound Iron Mixture. 
Dose, 16 c.c; 4 fl. dr. 



Action of Myrrh. 

External. — Locally applied it is mildly irritant to the skin 
and stimulant and disinfectant to mucous membranes and ulcer- 
ated surfaces. 

Internal. — Its internal, as well as its external, effects are due 
to its volatile oil. In moderate doses it is carminative, stimu- 
lant and tonic, and in large doses a gastro-intestinal irritant, 
exciting vomiting and purging. It is excreted by mucous mem- 
branes, especially the bronchial and the genito-urinary, and it 
is believed to increase the number of leucocytes in the blood. 
It has expectorant qualities and is also reputed to be a stimu- 
lant to the ovarian and uterine functions. 

Therapeutics of Myrrh. 

External. — The tincture is sometimes used for the removal 
of freckles, and a lotion or ointment containing myrrh may be 
applied as a stimulant and antiseptic dressing to indolent or 
unhealthy ulcers. In cases of eczema requiring moderate 
stimulation an ointment made by heating together myrrh with 
wax and oils has been found useful. The undiluted tincture 
may be applied to ulcerated gums, aphthous patches, and re- 
laxed uvula. Diffused in water (1 to 16), with the addition 
of a little carbolic acid or thymol, the tincture is a good mouth- 
wash for spongy gums, for mercurial ptyalism, or for wounds 
after operations upon the mouth, and may also be used as a 
gargle in pharyngitis, etc. As a mouth-wash it is very com- 
monly associated with borax, as in the following formula: 
Myrrh, 1; Cologne water, 16; borax, 1; water, 3; syrup, 3. 
Myrrh has long been employed as an ingredient of dentifrices. 

Internal. — Its internal administration is considered of ser- 
vice in checking excessive discharges: bronchorrhcea, leucor- 



BISMUTH. 673 

rhoea, cystitis, etc. It has some vogue as a disinfectant expec- 
torant for chronic bronchitis, and under the name of myrrholin 
a concentrated solution of one part of myrrh in one part of 
oil, conjoined with creosote, has been given in capsules in pul- 
monary tuberculosis. It has also been brought forward as a 
remedy for diphtheria, in which it is administered internally 
and likewise applied locally to the pharynx. In laryngeal diph- 
theria frequent inhalations are advised of from 8 to 15 c.c. (2 
to 4 fl. dr.) of a 2 per cent, mixture of myrrh. Myrrh is fre- 
quently prescribed with purgatives on account of its carmina- 
tive and stomachic properties, and, in combination with other 
remedies, is more or less employed in atonic dyspepsia and gas- 
tralgia. It is considered more especially useful in such condi- 
tions when they are associated with flatulence, mucous evacua- 
tions, constipation, and the presence of nervous disorders of a 
hysterical or hypochondriacal character. Here it may profit- 
ably be combined with vegetable bitters and iron. The com- 
pound iron mixture, in which myrrh is one of the chief con- 
stituents, is quite extensively used in amenorrhcea connected 
with anaemia and general torpor of the system. It has been 
doubted by some whether myrrh really has any effect on the 
menstrual function, its apparent value in amenorrhcea being due, 
it is alleged, to the iron, aloes, or other drugs usually combined 
with it. It has remained in use as an emmenagogue, however, 
for a very long time, and in this capacity still seems to retain 
the confidence of the profession. 

(b) Gastric Sedatives. 

BISMUTH. 

1. BISMTJTHT CITRAS.— Bismuth Citrate. Dose, 0.125 gm. (125 
milligm.) ; 2 gr. 

2. BISMUTHI ET AMMONII CITRAS.— Bismuth and Ammo- 
nium Citrate. Dose, 0.125 gm. (125 milligm.) ; 2 gr. 

3. BISMUTHI SUBCARBONAS.— Bismuth Subcarbonate. Dose, 
0.500 gm. (500 milligm.) ; 7% gr. 

4. BISMUTHI SUBGALLAS.— Bismuth Subgallate. (Dermatol.) 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

44 



674 PHARMACOLOGY AND THERAPEUTICS. 

5. BISMUTHI SUBNITRAS.— Bismuth Subnitrate. Dose, 0.500 
gm. (500 milligm.); 7y 2 gr. 

6. BISMUTHI SUBSALICYLAS.— Bismuth Subsalicylate. Dose, 
0.250 gm. (250 milligm.); 4 gr. 

Unofficial Preparations. 

Bismuthi Naphtholas. — Bismuth Naphtholate. (Beta-Naph- 
thol Bismuth.) Dose, .30 to 2.00 gm.; 5 to 30 gr. 

Bismuthi Oxidum. — Bismuth Oxide. Dose, .30 to 1.20 gm.; 
5 to 20 gr. 

Bismuthi Oxyiodidum. — Bismuth Oxyiodide. (Red Bismuth 
Oxyiodide. Bismuth Subiodide.) Dose, .30 to .60 m.; 5 to 
10 gr. 

Bismuthi Phenolas. — Bismuth Phenolate. (Phenol-Bismuth.) 
Dose, .30 to 2.00 gm.; 5 to 30 gr. 

Bismuthi Tetra-iodophenol-phthaleinas. — Bismuth Tetra- 
iodophenol-phthaleinate. (Eudoxin.) Dose, .30 to .50 gm.; 5 
to 8 gr. 

Bismuthi Tribromophenolas. — Bismuth Tribromophenolate. 
(Tribromophenol-Bismuth. Xeroform.) Dose, .30 to 2.00 gm.; 
5 to 30 gr. 

Action of Bismuth Salts. 

External. — Bismuth salts have no action on the unbroken 
skin. On raw surfaces they are antiseptic and mildly astrin- 
gent. When dusted on such a surface they form a protecting 
coat over it. Used in this way their value, as in the case of 
iodoform, probably depends not so much on their germicidal 
action as on their absorption of the fluids of the part, which 
renders the surface less favorable for the growth of bacteria. 

Internal. — When injected in large quantities directly into the 
circulation, bismuth salts produce, like arsenic, a relaxation of 
the walls of the capillaries, and it is believed that they have a 
direct action on the central nervous system and depress the 
vasomotor centre in the medulla. There is also a depressant 
action on the cardiac muscle, and from both these influences 
the blood-pressure falls rapidly. Late in the poisoning the 
heart is often found to stop entirely for some time, and then 
suddenly resume its action. The respiration is at first quick- 



BISMUTH. 675 

ened, and violent convulsions, both clonic and tonic, follow at 
short intervals, during which the movements are feeble and 
incoordinated. In some animals the respiration ceases before 
the heart, and in others the reverse of this is noted. The in- 
jection of smaller quantities is followed by more chronic effects, 
which resemble those met with in cases of poisoning in the 
human subject. In man medicinal doses of the insoluble salts, 
although maintained for a long period, produce very few appre- 
ciable symptoms. Any action which they may have in increas- 
ing peristalsis and the secretion of mucus in the stomach is 
probably simply that which would be caused by the presence 
of any heavy powder. In the intestine they are said to have 
some effect in augmenting the leucocytes of the blood, and 
they are apt to induce more or less constipation. The stools 
are blackened, a result which is generally supposed to be due 
to the formation in the large intestine of bismuth sulphide, but 
which is attributed by some to the reduction of bismuth in the 
bowel. Occasionally a purplish line makes its appearance on 
the gums. As long as bismuth was employed only internally, 
no serious effects were produced by its insoluble salts, as it is 
now known that certain cases of poisoning formerly ascribed 
to them were in reality due to the arsenic, lead or antimony 
with which they were contaminated. Since their use was ex- 
tended to the treatment of wounds and abraded surfaces, how- 
ever, several instances of dangerous intoxication have been 
observed, though the patients have generally recovered when 
the bismuth dressing was removed. Among the symptoms 
which have been noted may be mentioned black spots, or even 
gangrene, in the mouth and fauces, swelling of the gums, tongue 
and throat, increased flow of saliva, dysphagia, nausea, vomit- 
ing, diarrhoea and albuminuria. As much less bismuth is used 
for external applications than is often given by the mouth, it 
would appear either that the drug is more readily absorbed 
from raw surfaces than from mucous membranes or else that 
what is absorbed from the alimentary canal is prevented by 
the liver from reaching the general circulation. In animals in 



676 PHARMACOLOGY AND THERAPEUTICS. 

which chronic poisoning is induced by the intravenous or sub- 
cutaneous injection of moderate amounts of bismuth salts there 
are caused salivation, ulcerative stomatitis, gastro-intestinal 
irritation, muscular weakness and incoordination, and usually 
tetanic convulsions at intervals, while the urine contains albu- 
min and casts. The blood-pressure is low, as a result of the 
intestinal disturbance and general collapse, and complete paraly- 
sis eventually results. Post-mortem there are found ulcera- 
tions of the mouth and gums and of the large intestine, and 
inflammation and necrosis of the kidneys. There is also an 
intense black pigmentation of the upper part of the large intes- 
tine, which is limited very exactly by the ileo-csecal valve and 
which extends throughout the thickness of the bowel-wall. 
This is caused by the depositing of bismuth sulphide on the 
mucous membrane and in the capillary vessels and lymph 
spaces, and the ulceration found is no doubt due to the em- 
bolism which results from this precipitation in the vessels. 
Bismuth is excreted all along the alimentary canal, but par- 
ticularly in the large intestine, and also by the urine and pos- 
sibly by the milk; and is stored in considerable amount in the 
liver. In therapeutic doses bismuth salts, especially the naph- 
tholate act as antiseptics, and it is believed that the benefit 
derived from them is also due to some extent to their ridding 
the intestinal canal of hydrogen sulphide, in consequence of 
the avidity of bismuth for this irritant compound. 

Therapeutics of Bismuth Salts. 
External. — Bismuth salts are useful as dusting powders for 
ulcers and excoriated surfaces and as a dressing for wounds, 
when not too large. For such purposes the tribromophenolate 
and subgallate, the latter also known as dermatol, are preferable. 
The subnitrate and subcarbonate are also employed to some 
extent. In acne, vesicular eczema, intertrigo and the erythema 
of infants one of these salts may be lightly dusted over the 
surface. Bismuth compounds are also used in ointments, and 
the following will be found serviceable; Bismuth oxide (official 



BISMUTH. 677 

in B. P.), i part, and oleic acid, 8 parts, stirred in with 3 parts 
of white wax liquefied by heat, and with 9 parts of soft paraffin. 
By some the red oxyiodide is preferred to iodoform as an anti- 
septic for wounds and sores, and also for ointments for skin dis- 
eases, and it is recommended as an excellent application to 
chancre, chancroids, open buboes, ulcers, unhealthy wounds, 
and phlegmonous erysipelas. The subnitrate, snuffed into the 
nostrils, is sometimes employed in coryza and simple ozaena and 
as a tropical application in aphthous or nursing sore mouth, 
mercurial ptyalism, chronic conjunctivitis and granular lids. 
An ointment composed of bismuth subnitrate, boric acid, lanolin 
and olive oil has been found especially suited to the treatment 
of burns in children. The subnitrate, suspended in mucilage, 
may be used as an injection for gonorrhoea or leucorrhGea. It 
may also be applied in the form of soluble bougies and supposi- 
tories, and preparations of this kind are of service for ulcers 
of the rectum. 

Internal. — Bismuth salts are used internally chiefly for their 
local action upon the alimentary tract, as they form a protec- 
tive coating over the irritated or inflamed surfaces and keep 
them from coming in contact, and also exert an astringent, 
sedative and antiseptic influence. The ones perhaps most fre- 
quently prescribed are the subnitrate and subcarbonate, which 
are safer and also appear to be more efficient than the soluble 
salts. The latter when absorbed are likely to act as irritant 
poisons, and for this reason should not be used. The insoluble 
compounds are best given suspended in mucilage, which should 
be made with tragacanth, for when acacia is used a compact 
mass is formed at the bottom of the bottle. However they may 
effect these results, bismuth preparations are very efficacious in 
relieving gastric pain, whether due to organic disease, such as 
scirrhus, or to less serious causes, and also not infrequently in 
checking vomiting of whatever origin. They are said not to 
be beneficial in the gastralgia of chlorosis and hypochondriasis, 
nor in that produced by habitual constipation. In the latter 
condition they are naturally contra-indicated on account of 



678 PHARMACOLOGY AND THERAPEUTICS. 

their astringent effects. They are of great service in both 
acute and chronic gastritis, and also in gastric ulcer, where 
they not only alleviate the pain but contribute to the cure of 
the condition. In these painful affections their good effects 
are increased by having morphine combined with them. 

Sodium bicarbonate also often enhances their effects as gas- 
tric sedatives, but it should not be prescribed in a mixture with 
bismuth subcarbonate, as the formation of carbon dioxide is 
likely to result. Bismuth salts are also useful in the treatment 
of diarrhoea of various kinds. They are generally most effi- 
cient when given in large doses, and this is especially true in 
that of tuberculosis and in chronic diarrhoea. For internal use 
the phenolate and naphtholate are preferable to the inorganic 
salts. The subsalicylate is also a very useful preparation. It 
probably passes through the stomach unchanged to be broken 
up in the small intestine where it acts as an unirritating anti- 
septic. It has been proved to be a valuable remedy in the 
treatment of diarrhoeas, typhoid fever, and catarrhs of the ali- 
mentary tract. Reliable observations in Asiatic cholera prove 
that the tribromophenolate (xeroform) is a valuable intestinal 
antiseptic. Bismuth subgallate was formerly much employed in 
the treatment of gastro-intestinal indigestion, but has been 
largely supplanted by the more efficient naphtholate and tribro- 
mophenolate. 

Eudoxin (not official) is bismuth tetra-iodophenol-phthalein- 
ate, and occurs as a tasteless, odorless, reddish-yellow, insoluble 
powder. This is decomposed in the intestines, and is claimed 
to be a germicide. It is certainly known that iodine is liber- 
ated. It is employed as an intestinal antiseptic. 

TOXICOLOGY. 

When applied in large quantity to an exterior wounded surface suffi- 
cient bismuth may be absorbed to produce poisoning. This may also 
occur if glycerin is used to form an emulsion for injection into closed 
cavities (abscesses, joint-disease). 

Symptoms. — These are acute stomatitis with a peculiar blackish dis- 
coloration of the mucous membrane, generally upon the borders of 



CERIUM. 679 

the teeth and extending over the whole mouth, ulceration of the mucous 
membrane, intestinal catarrh, pain and diarrhoea. Even desquamative 
nephritis may be set up. 

Treatment. — Use demulcents. 

CERIUM. 

CERII OXALAS. — Cerium Oxalate. (Cerous Oxalate.) Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Action of Cerium Oxalate. 
Very little is known of the effects of cerium oxalate, but 
when injected into the circulation it is said to produce gastro- 
intestinal irritation, .with vomiting and diarrhoea and hyper- 
emia and ecchymoses of the mucous membranes, and also con- 
gestion or inflammation of the kidneys. It seems to be ab- 
sorbed with difficulty from the stomach and bowel. 

Therapeutics of Cerium Oxalate. 
It is used empirically as an anti-emetic, and especially for 
the vomiting from pregnancy, seasickness and other conditions 
in which gastric irritation is not the primary cause. It is not 
known how it acts in controlling emesis, but it is thought prob- 
able that its effects are local and similar to those of bismuth 
subnitrate. The dose above given is often exceeded; 2 gm. 
(30 gr.) have been frequently given with good results. Cerium 
oxalate appears to have some action as a sedative to the gastric 
mucous membrane, and so may allay the pain of gastralgia or 
prove beneficial in dyspepsia occasioned by deranged innerva- 
tion. In cases of cough (no doubt of reflex origin) associated 
with vomiting, it is sometimes of great service, and it has even 
been recommended for controlling excessive cough in phthisis 
or chronic bronchitis. In chronic diarrhoea it may be used in 
the place of bismuth. It has been thought to be of service in 
nervous dysmenorrhoea and such other nervous disorders as 
chorea and epilepsy, but it is difficult to see how this can be 
the case, and probably little reliance can be placed on it in this 
class of affections. 



68o PHARMACOLOGY AND THERAPEUTICS. 

D. Drugs Acting on the Intestines. 

(c) Purgatives. 

HONEY. 

MEL. — Honey. Dose, 4 c.c; 1 fl. dr. 

Preparations. 
Mel Depuratum (Mel Despumatum, U. S. P., 1890). — Clari- 
fied Honey. Dose, 4 c.c; 1 fl. dr. 

Mel Rosae. — Honey of Rose. Dose, 4 c.c; 1 fl. dr. 

Action of Honey. 
Honey is demulcent, nutritive and slightly laxative. Gener- 
ally it constitutes an agreeable article of diet. In some indi- 
viduals, however, it causes pyrosis, flatulence and colic, and in 
others an eruption of urticaria. 

Therapeutics of Honey. 
Honey is useful in relieving dryness of the mouth and facili- 
tating swallowing, and oxymel (clarified honey, 8; acetic acid, 
1; water, 1) is a pleasant addition to gargles or vehicle for 
astringents or expectorants. Honey is sometimes a sufficient 
laxative for the constipation of children. 

TAMARIND. 

TAMARINDTJS.— Tamarind. Dose, 16 gm.; 240 gr. 

Unofficial Preparation. 
Infusum Tamarindi. — Infusion of Tamarind. Dose, freely. 

Action of Tamarind. 
Tamarind is nutritive, laxative and refrigerant. 

Therapeutics of Tamarind. 
It may be given to fever patients or convalescents in infu- 
sion or in the form of tamarind whey (1 part of tamarind to 
30 of milk) as an acid, cooling, slightly purgative 'drink. As a 



MANNA. 68 1 

laxative it is often prescribed in association with other reme- 
dies, but in the case of children it may be given alone, spread 
upon bread and butter. 

FIG. 
FICUS.— Fig. 

Action of Fig. 
Fig is a pleasant and mildly purgative article of diet. The 
mucilaginous and saccharine constituents of the fresh fruit give 
it a laxative action. This effect in dried fig is largely due to 
the indigestible skins and seeds, which act mechanically in 
stimulating intestinal paralysis, but also have some tendency to 
create flatulence. 

Therapeutics of Fig. 

It may be used as a dessert to correct slight constipation, and 
confection of senna, in which fig is contained, is a very ser- 
viceable laxative for children. Split open and heated, fig may 
be employed, particularly in the mouth for gum-boils, etc., to 
fulfill the indications of a poultice. Poultices made with the 
dried fruit and milk have sometimes been found by surgeons 
to neutralize the most persistent fetor of cancerous and other 
ulcers. 

PRUNE. 

PRUNUM.— Prune. 

Action of Prune. 
Prune is demulcent, nutritive and slightly laxative. 

Therapeutics of Prune. 
It may be eaten, either raw or stewed, as an article of diet 
in cases of slight constipation. It is used as a corrective for 
senna in the confection. In " medicated prune " senna or podo- 
phyllin is added to give a more pronounced purgative effect. 

MANNA. 
MANNA.— Manna. Dose, 16 gm.; 240 gr. 



682 PHARMACOLOGY AND THERAPEUTICS. 

Action of Manna. 
Manna is aperient when taken in considerable quantities. 

Therapeutics of Manna. 
Manna is given as a mild laxative to children. It dissolves 
easily in milk, and is pleasant to the taste. 

CASSIA FISTULA. 
CASSIA FISTULA.— Cassia Fistula. (Purging Cassia.) Dose, 4 
gm.; 60 gr. 

Preparation. 
Confectio Sennae. — Confection of Senna. Dose, 4 gm.; 60 gr. 

Action of Cassia Fistula. 
Cassia-pulp is laxative in doses of 4 to 8 gm. (1 to 2 dr.), and 
in quantities sufficient to purge causes nausea, flatulence and 
griping. 

Therapeutics of Cassia Fistula. 
The pulp is administered as one of the ingredients of con- 
fection of senna, and in this country is rarely ever prescribed 
in any other form. 

CASTOR OIL. 
OLEUM RICINL— Castor Oil. Dose, 16 c.c; 4 ft. dr. 

Unofficial Preparation. 
Fluidextractum Ricini Foliorum. — Fluidextract of Ricinus 
Leaves. Dose, 2 to 8 c.c.; y 2 to 2 fl - dr - 

Action of Castor Oil. 

External. — Castor oil, like other bland fixed oils, is protec- 
tive and sedative when applied to the skin and mucous mem- 
branes. 

Internal. G astro -intestinal Tract. — The so-called unpleasant 
taste of castor oil is mostly due to the smell, and if the nose is 
held when the oil is swallowed loses most of its objectionable- 



CASTOR OIL. 683 

ness. It is non-irritant to the stomach, upoji which it produces 
no effects. When it reaches the intestine, however, it is de- 
composed by the digestive juices, and the ricinoleates thus 
formed are irritant and cause purgation. Castor oil may be 
taken in very large quantities without producing any other 
effect than that of a simple laxative. The seeds of the Ricinus 
communis contain an intensely poisonous toxalbumin, Ricin, 
which was at one time supposed to be the active principle of 
the oil, but it is now known that the latter is entirely free from 
this substance, and that its action is solely due to the ricinoleic 
acid of which it is the glyceride. A similar but less poisonous 
toxalbumin is found in the seeds of the Croton Tiglium, but 
does not enter into the composition of croton oil itself. It 
takes about five hours for castor oil to operate, the stools from 
it being soft, but not liquid, and it does not usually cause grip- 
ing. Even when rubbed into the skin, it is capable of acting 
on the bowels, and also when thrown into the rectum. It is 
absorbed from the intestine and disappears in the tissues like 
ordinary oils. A single dose is not followed by constipation, 
but this is very apt to result from the habitual use of the drug. 
The symptoms of poisoning by castor beans are violent abdom- 
inal pain, vomiting and purging, with collapse, and in fatal 
cases evidences of some severe gastro-enteritis have been found 
post mortem. 

Mammary Glands. — The leaves of Ricinus communis when 
applied to the breasts have some reputation as a galactagogue. 

Therapeutics of Castor Oil. 
On account of the mildness of its action, castor oil is one of 
the most useful drugs we have in cases where it is desired sim- 
ply to evacuate the alimentary canal. For instance, it is well 
adapted for getting rid of undigested food that is causing diar- 
rhoea. When irritating substances or hardened faeces are to be 
removed from the intestines it is the most efficient purgative 
compatible with safety. Formerly it was advised, as a routine 
practice, to give a dose of castor oil early on the morning of 



684 PHARMACOLOGY AND THERAPEUTICS. 

the third day after parturition, for the purpose of modifying 
the severity of the so-called milk-fever. Since the general in- 
troduction of the thermometer into practice, however, and the 
better understanding of the causes of febrile temperatures in 
the puerperal state, the existence of a distinct milk-fever refer- 
able to functional disturbance in the breasts during the period 
in question has been found to be an entirely exceptional occur- 
rence. Still, although the administration of this particular 
laxative at this time has largely fallen into disuse, the canonical 
practice of opening the patient's bowels on the third day is of 
unquestionable utility, for the reason that very few women 
escape from an accumulation of faecal matter during the last 
weeks of pregnancy, which is often very great and which cre- 
ates a predisposition to puerperal affections. In some an ordi- 
nary injection of soap and olive oil in water suffices to procure 
an adequate evacuation ; in others, compound liquorice powder, 
compound rhubarb pill, or a dose of some cathartic mineral 
water. In obstinate cases a calomel purge may be called for. 
A very favorite post-partum combination is a pill composed of 
compound extract of colocynth, extract of hyoscyamus, pow- 
dered socotrine aloes, and extract of nux vomica, with a small 
quantity of podophyllin and ipecacuanha. By some of the best 
obstetricians castor oil is now given only in cases of severe 
colic, in which it is sometimes found advisable to combine with 
it a small dose of laudanum. When inflamed haemorrhoids, 
fissures of the anus or surgical operations on the pelvic viscera 
require the use of a certain, but mild and unirritating, laxative, 
castor oil should be selected. It is often very useful in the 
temporary constipation of children, as well as in diarrhoea in 
young subjects induced and maintained by undigested food or 
irritating secretions. In the latter condition the oil may be 
followed with advantage by an opiate or an enema containing 
laudanum, and in some forms of diarrhoea, both in adults and 
children, a small quantity of laudanum is frequently adminis- 
tered with it. In the dysentery of children and the sporadic 
dysentery of adults, especially after the more acute febrile 



CASTOR OIL. 685 

symptoms have subsided, an emulsion of castor oil made with 
mucilage of acacia (to which laudanum or paregoric may be 
added if the symptoms are severe), is generally of great 
service. It may also prove valuable in the entero-colitis of 
infants and young children. In these cases the amount of oil 
in each dose should be quite small. Except in the case of 
aspidium (see Aspidium), castor oil is a good purgative to give 
before and after the use of anthelmintics. It is not suited for 
cases of chronic constipation. As an enema it does not appear 
to possess any advantages over olive oil. One part of castor 
thoroughly mixed with five parts of warm olive oil may be used 
for a mild injection. 

As most persons object to taking castor oil by itself, it is 
generally necessary to disguise its taste in some way. It may 
be given in soft capsules, which can be obtained of any desired 
size. If for any reason these are objectionable, it is best ad- 
ministered in the beverage known as sarsaparilla. Lemon 
juice or coffee conceals the taste to some extent, and the fol- 
lowing is recommended as a good way in which to take it: 
The oil is added to 4 c.c. (1 fl. dr.) of peppermint water, and 
then a little brandy added till the oil neither sinks nor floats. 
If the inside and rim of the glass are moistened with the vehicle, 
the oil, which should, if possible, be between two layers of the 
vehicle, is scarcely tasted. In the same way it may be taken in 
the froth of ale or beer. In the B. P. a mixture is official 
which is composed of castor oil, 6; mucilage of acacia, 3; 
orange-flower water, 2, and cinnamon water, 5, and various 
other more or less palatable mixtures have been recommended. 
The extemporaneous dose prepared at the soda-water fountain 
is preferred by many persons. Castor oil with balsam of Peru 
(see Balsam of Peru) makes an excellent surgical dressing 
which is applicable for burns, wounds, abscesses, and many 
other conditions, and the oil is occasionally used as a basis for 
ointments for the treatment of alopecia. A drop of the oil in 
the eye will often relieve the irritation caused by a foreign 
body or by granular lids. A poultice made of the leaves of 



686 PHARMACOLOGY AND THERAPEUTICS. 

the castor-oil plant may be applied to the breasts to promote 
the secretion of milk, and a fluidextract of the leaves (not offi- 
cial), taken three or four times a day and also locally applied, 
is likewise supposed to have some effect in increasing this. 



(b) Simple Purgatives. 



ALOES. 



ALOE (Aloe Barbadensis, Aloe Socotrina, U: S. P., 1890). — Aloes. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparations. 

1. Aloe Purificata. — Purified Aloes. Dose, 0.250 gm. (250 
milligm.); 4 gr. 

2. Extractum Aloes. — Extract of Aloes. Dose, 0.125 gm. 
(125 milligm.); 2 gr. 

3. Pilulae Aloes. — Pills of Aloes. Dose, 2 pills. 

4. Pilulae Aloes et Ferri. — Pills of Aloes and Iron. Dose, 2 
pills. 

5. Pilulse Aloes et Mastiches. — Pills of Aloes and Mastic. 
(Lady Webster's pill.) Dose, 2 pills. 

6. Pilulae Aloes et Myrrhae. — Pills of Aloes and Myrrh. 
Dose, 2 pills. 

7. Tinctura Aloes. — Tincture of Aloes. Dose, 2 c.c; 30 TTt- 

8. Tinctura Aloes et Myrrhae. — Tincture of Aloes and 
Myrrh. Dose, 2 C.C.; 30 TTt. 

Unofficial Preparation. 
Pilulae Aloes et Asafcetidae. — Pills of Aloes and Asafetida. 
Dose, 1 to 5 pills. 

ALOINUM.— Aloin. Dose, 0.065 gm. (65 milligm.); 1 gr. 

Preparation. 
Pilulae Laxativae Compositae. — Compound Laxative Pills. 
Dose, 2 pills. 

Action of Aloes. 
External. — Aloes has no action on the unbroken skin, but is 
thought to be slightly stimulating to denuded surfaces. Pow- 
dered aloes, dusted upon an abrasion, blister or ulcer, is capable 



ALOES. 68? 

of being absorbed and producing the characteristic internal 
effects of the drug. 

Internal. Gastro-intestinal Tract. — Like other substances 
having a strong bitter taste, aloes, in small doses, acts as a 
stomachic. It is a slowly acting but efficient cathartic. Its 
main action is shown in the stimulation of the large intestine, 
particularly the rectum, and the result of this is chiefly muscular 
contraction, though some increase of secretion is also produced 
by it. The presence of bile in the intestine is necessary to elicit 
its full effects, and it is believed itself to cause some increased 
secretion of bile, as indicated by the dark character of the 
passages from it. If given alone it usually causes a consider- 
able amount of griping pain. Aloin is regarded as less certain 
in its purgative action than aloes, and there can be little ques- 
tion, it is thought, that the crystalline aloin itself is inactive 
in the bowel, but is there changed under certain conditions to 
an amorphous compound which has irritant effects. It is 
stated, however, that a warm solution of aloin will produce 
purgation if injected subcutaneously. 

Pelvic Organs. — Aloes produce a comparatively marked con- 
gestion of the pelvic organs, and is therefore regarded as an 
emmenagogue. 

Excretion. — It is readily absorbed, and is eliminated through 
the bowels and kidneys, and also in the milk. It is quite likely 
that the habitual use of the drug will result in irritation of the 
kidney. 

Therapeutics of Aloes. 

As it usually requires from twelve to fifteen hours, or more, 
to act on the bowels, it is customary to administer it compara- 
tively early in the evening in order to secure a movement from 
it in convenient season on the following morning. On account 
of the griping which it is apt to cause if employed alone, it is 
usually associated with carminatives or other agents calculated 
to promote greater regularity of peristaltic contraction. A 
small amount of extract of hyoscyamus or extract of bella- 
donna generally answers very well. The bitter principles of 



688 PHARMACOLOGY AND THERAPEUTICS. 

aloes are of service in aiding digestion, and a very good dinner 
pill is composed of .06 gm. (1 gr.) of extract of aloes and .015 
gm. (14 gr.) of extract of mix vomica. If the faeces are hard, 
.03 gm. (y 2 gr.) of powdered ipecacuanha should be added. 
Such a pill, with the addition of .06 or .12 gm. (1 to 2 gr.) of 
ferrous sulphate is often very useful in anaemia. For cases of 
chronic constipation, especially in children and also in persons 
of middle age, many of which are due to an imperfect contrac- 
tion of the muscular coat of the large intestine, aloes is an 
excellent purgative. If given in moderate doses, it has the 
advantage of not producing subsequent constipation, and, in 
addition, of seldom requiring an increase in the dose. Simple 
jaundice, of an atonic kind, and jaundice, or at least a bilious 
state, in which the tongue is coated, the breath foul, the abdo- 
men tumid, and the colon impacted, may usually be successfully 
treated with this remedy. The constipation of hypochondriasis 
and melancholia also is best overcome by the use of aloes, and, 
with the removal of the impacted faeces, there is not infre- 
quently an improvement in the mental state. In cerebral dis- 
orders when purgatives are indicated for their derivative effect, 
this is the one commonly selected. In cases of hysteria, with 
anaemia and constipation, the pills of aloes and asafetida, which 
have also a carminative effect, may be given. Combined with 
iron and asafetida or myrrh, aloes is used to a considerable 
extent in the treatment of amenorrhoea, whether associated 
with chlorosis or not. It is generally prescribed on account of 
its tendency to induce hyperaemia of the pelvic organs, but it 
seems quite possible that the relief by it of the constipation 
which is so commonly present in these cases is largely, if not 
chiefly, responsible for the improvement which frequently takes 
place under its use. It is often stated that aloes is contra- 
indicated in cases of menorrhagia. This is no doubt true as 
regards full-blooded subjects, but when this condition occurs in 
the debilitated and relaxed, it is sometimes relieved by the drug. 
As to the risk of employing it in pregnancy, lest the fullness 
of the uterine vessels induced by it may lead to abortion, which 



RHUBARB. 



689 



has also been suggested by writers, it would appear doubtful 
whether the danger from aloes in this respect is greater than 
that from any other active cathartic. The presence of haemor- 
rhoids has been regarded as another contra-indication, but if 
a patient suffers from haemorrhoids which are not inflamed, 
aloes can be safely administered, and even with marked benefit 
if they are due to a relaxed rectal mucous membrane. In gon- 
orrhoea aloes has been used both internally and by injection, 
after the acute inflammation has subsided. The following 
enema may be given for ascarides : Aloes, 8; potassium carbon- 
ate, 3; mucilage of starch, 960. As the purgative principle of 
aloes is excreted to some extent in the milk, the drug should be 
avoided or given with great caution in the case of nursing 
women, on account of the danger of its causing diarrhoea in the 
infant. 

RHUBARB. 

RHEUM.— Rhubarb. Dose, 1 gm.; 15 gr. 



Preparations. 

1. Extractum Rhei. — Extract of Rhubarb. Dose, 0.250 gm. 
(250 milligm.); 4 gr. 

2. Fluidextractum Rhei. — Fluidextract of Rhubarb. Dose, 
1 c.c; 15 n\. 

3. Pilulae Rhei Composite. — Compound Pills of Rhubarb. 
Dose, 2 pills. 

4. Pulvis Rhei Compositus. — Compound Powder of Rhu- 
barb. Dose, 2 gm.; 30 gr. 

5. Syrupus Rhei. — Syrup of Rhubarb. Dose, 8 c.c; 2 fl. dr. 

6. Syrupus Rhei Aromaticus.— Aromatic Syrup of Rhubarb. 
(Spiced Syrup of Rhubarb.) Dose, 8 C.C.; 2 fl. dr. 

7. Tinctura Rhei. — Tincture of Rhubarb. Dose, 4 C.C.; 1 
fl. dr. 

8. Tinctura Rhei Aromatica. — Aromatic Tincture of Rhu- 
barb. Dose, 2 c.c; 30 TT\. 

9. Mistura Rhei et Sodse. — Mixture of Rhubarb and Soda. 
Dose, 4 c.c: 1 fl. dr. 



45 



69O PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparations. 

Pilulae Rhei (U. S. P., 1890).— Pills of Rhubarb. Dose, 3 to 
5 pills. 

Tinctura Rhei Dulcis (U. S. P., 1890).— Sweet Tincture of 
Rhubarb. Dose, 15 to 30 c.c; y 2 to 1 fl. oz. 

Action of Rhubarb. 

External. — Rhubarb is never used for external application. 
If it were so applied, it would probably give rise to a mild irri- 
tation in consequence of its chrysarobin, which by itself excites 
inflammation of the skin. 

Internal. Alimentary Canal. — In the mouth, rhubarb slightly 
increases the salivary secretion. In moderate doses it is sto- 
machic, by reason of its bitter resins, increasing gastric secre- 
tion, peristalsis, vascularity and absorption, and thus promoting 
digestion. In larger doses it has a purgative action, producing 
in from four to eight hours, generally with some griping, *a 
soft, though not watery, evacuation which is of a yellowish- 
brown color, due to the chrysarobin. The purgative properties 
of the drug have been attributed to the chrysarobin, although, 
chrysophanic acid, which it yields, is stated not to cause purga- 
tion, on account of its rapid absorption. Rhubarb has some 
effect in increasing the biliary secretion, but its cholagogue 
action is not sufficiently marked to entirely explain its pur- 
gative properties. It probably also increases the excretion 
of bile by accelerating its passage through the intestine and 
preventing its reabsorption. Rhubarb, as well as podophyllin 
and resin of jalap, is said to require the presence of bile 
in the intestine as a necessary condition for its operation, 
so that in its absence these drugs may be either altogether 
inactive or much less energetic than usual. It is often stated 
that rhubarb affects chiefly the muscular coat of the intestine, 
and thus purges by increasing peristalsis, but no satisfactory 
proof of this has apparently been educed. The purgative action 
is succeeded by constipation, due, no doubt, to the astringent 
effect of the rheotannic acid. This is presumably absorbed 
quickly and subsequently excreted back into the bowel, for were 



RHUBARB. 



69I 



it not thus soon absorbed it would be swept away in the evacua- 
tions and would have no opportunity of producing its astrin- 
gent action. 

Kidneys. — Rhubarb has the effect of slightly increasing the 
amount of urine. The excretion of chrysophanic acid gives a 
yellowish color to this fluid, and also to the milk of nursing 
women. Rhubarb urine may be distinguished from that of 
jaundice by its becoming purplish-red on the addition of an 
alkali. 

Skin. — The skin may also assume a yellowish tinge from the 
presence of chrysophanic acid, and in rare instances cutaneous 
eruptions of different kinds are produced. 



Therapeutics of Rhubarb. 
Rhubarb is an excellent purgative for the indigestion of chil- 
dren, whether attended by diarrhoea or not, as it efficiently 
clears the intestinal canal of undigested food and irritating 
secretions, and its stomachic and after-astringent effects often 
serve a very useful purpose. A very satisfactory stomachic 
for young children consists of equal parts of powdered rhubarb 
and sodium bicarbonate (which conceals the taste of the rhu- 
barb), with the addition of some powdered gentian; or, if pre- 
ferred, the same remedies may be associated in a liquid mixture. 
The aromatic syrup combined with an alkali is especially ser- 
viceable in the summer complaints of children when the stools 
are greenish and mucous. Rhubarb is much used in diarrhoea, 
with intestinal weakness or relaxation, to unload the bowels of 
acrid secretions. In small doses, the tincture is a good sto- 
machic tonic in dyspepsia with deficient biliary and intestinal 
secretions. On account of the griping which it is apt to occa- 
sion, rhubarb should rarely be prescribed alone, though in habit- 
ual constipation some individuals find benefit from chewing the 
root. Notwithstanding its astringent property, rhubarb is 
largely used as an habitual laxative, as it not only does not 
impair, but improves the appetite and digestion. It is adapted 
to those of relaxed habit, and should not be given in a high 



692 PHARMACOLOGY AND THERAPEUTICS. 

sthentic state of the system, with hyperemia of the mucous 
membrane, or when depletion is necessary. For the treatment 
of constipation, however, it has the disadvantage of requiring 
to be frequently repeated, its astringent after-effect being in 
many cases a decided objection. The compound rhubarb pill 
is a mild and efficient preparation for moving the bowels. It 
is often combined with calomel to act upon the so-called torpid 
liver, as in Quain's pill, which is calomel, .06 gm. (1 gr.) with 
compound rhubarb pill; .20 gm. (3 gr.). 

BUTTERNUT. 

Unofficial Preparations. 

Juglans (U. S. P., 1890). — Juglans. (Butternut.) Dose, 4 
to 8 gm.; 1 to 2 dr. 

Extractum Juglandis (U. S. P., 1890). — Extract of Juglans. 
Dose, 0.30 to 2.00 gm.; 5 to 30 gr. 

Action of Butternut. 
Butternut is a mild cathartic, and resembling rhubarb in the 
property of evacuating, without debilitating, the alimentary 
canal. 

Therapeutics of Butternut. 
Butternut has some reputation in dysentery and in chronic 
constipation. It was much employed during the war of the 
Revolution. 

CASCARA SAGRADA. 

RHAMNUS PURSHTANA.— Cascara Sagrada. (Sacred Bark.) 
Dose, 1 gm.; 15 gr. 

Preparations. 

1. Extractum Rhamni Purshianae. — Extract of Cascara Sa 
grada. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

2. Fluidextractum Rhamni Purshianse. — Fluidextract of 
Cascara Sagrada. Dose, 1 C.C.; 15 hi,. 

3. Fluidextractum Rhamni Purshianse Aromaticum. — Aro- 
matic Fluidextract of Cascara Sagrada. Dose, 1 C.C.; 15 m\. 



CASCARA SAGRADA. 693 

Action of Cascara Sagrada. 
The fresh bark is emetic, but after it has been kept for about 
two years this action is lost. Cascara sagrada is a simple, but 
efficient, purgative, which does not occasion much griping. Its 
action resembles that of buckthorn, but it is more powerful 
and certain in its operation. One of the advantages of this 
drug is that it overcomes constipation without purging, and 
consequently without weakening, and the stomachic properties 
which it derives from its bitter principle add to its value by 
improving the appetite and digestion. 

Therapeutics of Cascara Sagrada. 
Although introduced only a few years ago, cascara sagrada 
has established itself as a favorite and reliable remedy in habit- 
ual constipation. It should not be employed as a purgative 
when a powerful impression is required. It does not operate 
hurriedly or urgently, like many purgatives which produce 
watery stools, and is best suited to cases of simple constipation, 
or of torpor of the colon without associated disease. It may 
be given for the relief of catarrhal jaundice, as well as of 
haemorrhoids and affections of the pelvic organs, and is often 
very useful in cases of dyspepsia accompanied by constipation. 
A special virtue of cascara sagrada is that in its continued use 
gradually increasing doses are unnecessary. As the condition 
improves the daily quantity may be reduced, and a considerable 
number of cases of chronic constipation are eventually cured 
by the drug. As the fluidextract is very bitter, it is advisable 
that its taste should be covered by aromatics, liquorice or sal 
volatile, or it may be administered in chloroform water. The 
aromatic syrup (B. P., liquid extract of cascara, 8; tincture 
of orange, 2 ; alcohol — 90 per cent. — 1 ; cinnamon water, 3 ; 
syrup, 6) also conceals the taste satisfactorily. The liquid 
extract is made with alcohol (90 per cent.) and water. A 
preparation known as Tinctura Laxativa, consisting of equal 
parts of fluidextract of cascara sagrada, aromatic spirit of 
ammonia, spirit of chloroform, tincture of belladonna leaves, 



694 PHARMACOLOGY AND THERAPEUTICS. 

and tincture of nux vomica, is miscible in water and constitutes 
a pleasant simple purge which is highly recommended in habit- 
ual constipation. The dose is 1.20 to 4 c.c. (20 to 60 ill). 
The official aromatic fluidextract is an excellent preparation, 
and some of the unofficial preparations now made, such as 
" Cascara Cordial," are very palatable, and seem to be quite 
efficient as laxatives. The drug is also sold in various pills and 
tablets. The preparations of cascara sagrada have to some 
extent supplanted the compound liquorice powder, which was 
formerly in very general use. 

SENNA. 
SENNA.— Senna. Dose, 4 gm.; 60 gr. 

Preparations. 

1. Confectio Sennse. — Confection of Senna. Dose, 4 gm.; 
60 gr. 

2. Fluidextractum Sennas. — Fluidextract of Senna. Dose, 2 
c.c; 30 hi.. 

3. Infusum Sennae Compositum. — Compound Infusion of 
Senna. (Black Draught.) Dose, 120 C.C.; 4 fl. OZ. 

4. Pulvis Glycyrrhizae Compositus. — Compound Powder of 
Glycyrrhiza. (Compound Liquorice Powder.) Dose, 4 gm.; 
60 gr. 

5. Syrupus Sennae. — Syrup of Senna. Dose, 4 c.c; 1 fl. dr. 

Action of Senna. 

External. — None. 

Internal. — Senna is one of the class of drugs, including rhu- 
barb, aloes, frangula and cascara sagrada, which are known as 
the anthracene purgatives, because they owe their activity to 
the presence of certain irritant anthracene (C 14 H 10 ) compounds. 
Only a few of the latter have as yet been isolated. Senna dif- 
fers from rhubarb in the absence of any astringent property, 
and its use is not followed by constipation. It is somewhat 
more liable to induce griping and nausea than rhubarb, but its 
tendency to gripe may be almost abolished, without greatly 



SENNA. 695 

reducing its activity, by first exhausting it with strong alcohol. 
Generally five or six hours elapse between its administration 
and the first action of the bowels, and the stools resulting from 
it are watery and of a pale yellow color. Senna has little or 
no action on the secretion of bile. The cathartic acid in it is 
supposed to stimulate the muscular coat of the intestine, espe- 
cially the colon, occasioning some hyperemia, and, in conse- 
quence, the contents of the small intestine are hurried through 
the lower bowel, so that some undigested food may appear in 
the motions. Some observers state that senna acts directly as 
a stimulant upon the mucous membranes, and so produces a 
local peristalsis as it is moved along. It will cause purgation, 
however, if it is injected into the circulation, and this is prob- 
ably because cathartic acid is excreted into the bowel. While 
this acid is by far the most important purgative principle of 
senna, there is reason to suppose that there are other substances 
in it which also have such action. Some constituents of the 
drug are absorbed and the chrysophan (chrysarobin) may 
cause discoloration of the urine, staining it carmine if that fluid 
is alkaline, or yellow if it is acid. The purgative properties of 
the drug may be imparted to the milk of nursing women, and 
therefore senna should be used with caution in this class of 
patients. 

Therapeutics of Senna. 
The most active preparation is an extemporaneous infusion, 
which should not, however, be boiled very long. It soon under- 
goes decomposition if left to itself, but this may be prevented 
by adding nitre to it (1 to 480). Senna is a safe and reliable 
purgative for cases of simple constipation, but is usually com- 
bined with other remedies. As it acts largely upon the colon, 
it is serviceable in slight cases of faecal accumulation. It is 
useful to complement the action of duodenal purgatives, and 
an illustration of this is seen in the old prescription of a blue 
pill at night and black draught in the morning. As the com- 
pound infusion of senna is a very disagreeable mixture, how- 
ever, the compound liquorice powder is preferable to it. The 



696 PHARMACOLOGY AND THERAPEUTICS. 

latter preparation is still used to a considerable extent in habit- 
ual constipation, especially among children, and in the consti- 
pation of pregnancy. In pregnant women and other patients 
when cascara sagrada alone will not move the bowels, senna is 
sometimes combined with it with good effect. Confection of 
senna is also a very satisfactory preparation for children, and 
especially in the form of Tamar Indien, in which it is coated 
with sugar or chocolate and which is readily taken by them. 
In the case of children manna is often combined with senna, 
and an excellent laxative mixture consists of fluidextract of 
senna, manna and magnesium carbonate, with syrup of ginger 
and water. Coffee has been recommended for masking the 
disagreeable taste of senna. 8 gm. (2 dr.) of senna and 4 gm. 
(1 dr.) of coffee may be infused in 90 c.c. (3 fl. oz.) each of 
hot milk and boiling water, and the whole drunk after twelve 
hours. 

FRANGULA. 
FRANGULA.— Frangula. (Buckthorn.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Frangulae. — Fluidextract of Frangula. Dose, 
1 c.c; 15 ttl. 

Action of Frangula. 
The fresh bark is a violent gastro-intestinal irritant, but that 
which has been kept a year is a mild purgative, acting like senna. 

Therapeutics of Frangula. 
It is suitable for children, and for use in chronic constipation. 

OXGALL. 
Fel Bovis. — Oxgall. (Fel Tauri.) 

Preparation. 
Fel Bovis Purificatum.— Purified Oxgall. Dose, 0.500 gm. 
(500 milligm.); 7V 2 gr. 



EUONYMUS. 697 

Action of Oxgall. 
Oxgall when added to albuminous solutions delays their de- 
composition. It aids in the absorption of fats. If given by the 
mouth it is mostly absorbed from the intestine and acts as a 
cholagogue. 

Therapeutics of Oxgall. 
Oxgall has been used as a cholagogue purgative, not infre- 
quently associated with aloes. Although theoretically of value 
in replacing deficient biliary secretion, it has the great disad- 
vantage of disturbing the gastric digestion, and on this account 
is not now very much employed. It may be found useful, how- 
ever, when given as an enema in cases of impacted faeces in 
which there is not sufficient room in the rectum for a bulky 
injection. For this purpose 30 to 60 gm. (1 to 2 fl. oz.) of 
oxgall in 500 c.c. (1 pint) of water should be used. It is claimed 
that bile has some antitoxic power with reference to the poi- 
sons produced by pathogenic micro-organisms, and oxgall has 
sometimes been used as an antiseptic in typhoid fever and in 
intestinal fermentation. 

(c) Drastic purgatives. 

EUONYMUS. 

EUONYMUS.— Euonymus. (Wahoo. Spindle Tree.) Dose, 0.500 
gm. (500 milligm.); 7 l / 2 gr. 

Preparations. 

Extractum Euonymi. — Extract of Euonymus. (Euonymin.) 
Dose, 0.125 gm. (125 milligm.); 2 gr. 

Fluidextractum Euonymi. — Fluidextract of Euonymus. 
Dose, 0.5 c.c.; 8 HI. 

Action of Euonymus. 

In small doses euonymus is a gastric stimulant, promoting 

appetite and digestion. In both moderate and large doses it is 

also regarded as an hepatic stimulant, increasing the biliary 

secretion, while in the latter amounts it is distinctly irritant 



698 PHARMACOLOGY AND THERAPEUTICS. 

to the intestine and is an energetic purgative. It owes its 
activity to its euonymin, a substance which has the same 
action on the heart as digitalis. The drug is also said to have 
slight diuretic and expectorant effects. Beyond its tonic and 
purgative properties it probably has no special virtue. 

Therapeutics of Euonymus. 
It has been chiefly employed in cases of constipation asso- 
ciated with impaired functional derangement of the liver, and 
is often combined with calomel. In dyspepsia its administra- 
tion two or three times a week is sometimes attended with good 
results. 

IRIS. 

Unofficial Preparations. 

Iris (U. S. P., 1890).— Iris. (Blue Flag.) Dose, 0.60 to 
2.00 gm.; 10 to 30 gr. 

Extractum Iridis (U. S. P., 1890). — Extract of Iris. Dose, 
0.05 to 0.015 gm.; 1 to 3 gr. 

Extractum Iridis Fluidum (U. S. P., 1890). — Fluidextract of 
Iris. Dose, 0.60 to 2 c.c; 10 to 30 TT\. 

Iridinum. — Iridin. (Irisin.) Dose, 0.05 to 0.30 gm.; 1 to 
5 gr. 

Action of Iris. 
Iris is a cholagogue and hydragogue cathartic. Like euony- 
mus, it is stimulant to the intestinal glands, but it is more 
powerfully purgative than that drug, and is also more apt to 
create gastric disturbance. As in the case of other cathartics 
of its class, moderate quantities do not appear to induce griping 
so frequently as some of the anthracene purges. It is credited 
with some diuretic action. 

Therapeutics of Iris. 
It may be used in dropsy, for the purpose of causing diuresis 
as well as purgation, and it has been found an efficient cathar- 
tic in malarial and catarrhal jaundice and bilious remittent 
fever. It is also said to exert a specific influence in enlarge- 



PODOPHYLLUM. 699 

ment of the thyroid gland. It is a common practice to com- 
bine iridin, which has a cholagogue action, with euonymin, 
calomel, podophyllin or similar purgatives. 

CELANDINE. 

Unofficial Preparation. 

Chelidonium (U. S. P., 1890). — Chelidonium. (Celandine.) 
Dose, 1.0 to 4.0 gm.; 15 to 60 gr. 

Action of Celandine. 
Celandine apparently possesses a stimulating effect upon the 
hepatic secretions. It is a somewhat irregularly acting purga- 
tive, giving rise to watery motions, but at the same time to 
griping pains. 

Therapeutics of Celandine. 
It has been found useful in jaundice, and it constituted the 
chief ingredient in the old Decoctum ad Ictericos of the Edin- 
burgh Pharmacopoeia. 

PODOPHYLLUM. 

PODOPHYLLUM.— Podophyllum. (May Apple. Mandrake.) Dose, 
0.500 gm. (500 milligm.) ; 7y 2 gr. 

Preparations. 

1. Fluidextractum Podophylli. — Fluidextract of Podophylli. 
Dose, 0.5 c.c; 8 TH.. 

2. Resina Podophylli. — Resin of Podophyllum. (Podo- 
phyllin.) Dose, (purgative) 0.015 gm. (15 milligm.); y 4 gr.; 
(laxative) 0.005 gm. (5 milligm.); T \ gr. 

3. Pilulae Podophylli, Belladonnse et Capsici. — Pills of Podo- 
phyllum, Belladonna and Capsicum. Dose, 1 pill. 

4. Pilulae Catharticae Vegetables. — Vegetable Cathartic 
Pills. Dose, 2 pills. 

Unofficial Preparation. 
Extractum Podophylli (U. S. P., 1890). — Extract of Podo- 
phyllum. Dose, .10 to .60 gm.; 2 to 10 gr. 



/OO PHARMACOLOGY AND THERAPEUTICS. 

Action of Podophyllum. 

External. — Podophyllum is irritant to the skin and mucous 
membranes and from denuded surfaces it may be absorbed and 
produce a purgative effect. 

Internal. G 'astro-intestinal Tract. — Podophyllin is a drastic 
purgative. Large doses cause marked gastro-intestinal irrita- 
tion, and have been known to prove fatal from acute inflamma- 
tion of the bowel. Medicinal doses occasion considerable colic 
and in some instances nausea. Podophyllin is like aloes in the 
slowness of its action, catharsis rarely occurring earlier than 
ten or twelve hours after its administration, and sometimes not 
for twenty to twenty-four hours. The watery passages which 
it produces are stained dark by the presence of bile. In small 
doses podophyllin probably increases the secretion of that fluid 
— at all events, under its action there is an augmentation of the 
solids in it. When it is given in purgative doses the quantity 
of bile is said not to be increased, though more of it is emptied 
from the gall bladder into the intestine. Podophyllin would 
thus seem to act both as a direct and indirect cholagogue. An 
old name for this drug is Vegetable Mercury. Both podophyl- 
lin and podophyllotoxin cause purgation when injected subcu- 
taneously, and this is probably because after absorption they 
are excreted into the bowel, since they have been detected in 
the faeces when administered in this way. Podophyllotoxin 
occasions the formation of methaemoglobin in the red corpuscles 
when added to blood outside the body, and when thrown into 
the circulation in large amount gives rise to glomerular nephri- 
tis and haemorrhages into various organs. While it has a de- 
pressant effect upon the central nervous system, this is thought 
to be indirect, and due to the shock and haemorrhage resulting 
from its severe intestinal action. 

Therapeutics of Podophyllum. 
As podophyllum is believed to act especially on the liver, it 
is quite largely employed in constipation with hepatic derange- 
ment, and particularly in so-called bilious attacks. In conges- 



LEPTANDRA. JO I 

tion of the portal circulation, in catarrhal and malarial jaun- 
dice, and in ascites it generally acts with great efficiency, and 
haemorrhoids of recent formation which bleed in consequence 
of stasis in the portal circulation may sometimes be cured by 
a brisk podophyllum cathartic. Habitual constipation due to 
inactivity of the muscular coat of the intestine may also be 
cured by the nightly use of a small dose of podophyllin com- 
bined with belladonna. The resin has been recommended for 
infants one or two months old who have hard, stony stools, .12 
c.c. (2 HI), or more, of a solution of .06 gm. (1 gr.) of podo- 
phyllin in 4 c.c. (1 fl. dr.) of alcohol being used on sugar once 
or twice a day. It should not be given in association with 
promptly acting purgatives, as in that case it will be carried 
through the bowel before it has had time to produce its effects. 
It may often be advantageously combined with belladonna, nux 
vomica, or with hyoscyamus to prevent griping. The only 
preparation that should be employed is the resin (podophyllin), 
and this is almost universally administered in pill form. 

LEPTANDRA. 
LEPTANDRA. — Leptandra. (Culver's Root.) Dose, 1 gm.; 15 gr. 

Preparations. 

1. Extractum Leptandrse. — Extract of Leptandra. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

2. Fluidextractum Leptandrae. — Fluidextract of Leptandra. 
Dose, 1 c.c; 15 TIL 

3. Pilulae Catharticse Vegetabiles. — Vegetable Cathartic 
Pills. Dose, 2 pills. 

Action of Leptandra. 
Recent leptandra root acts as a violent cathartic, and some- 
times as an emetic. It is an excellent cholagogue, owing its 
activity to leptandrin, and appears to have a special influ- 
ence upon the muciparous follicles of the intestine. 



702 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Leptandra. 
It acts very advantageously in cases of duodenal indigestion 
and chronic constipation. 

SCAMMONY. 

SCAMMONIUM.— Scammony. Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Preparation. 
Resina Scammonii. — Resin of Scammony. Dose, 0.200 gm. 
(200 milligm.); 3 gr. 

Action of Scammony. 
Scammony, which consists very largely of jalapin, is a hydra- 
gogue cathartic of rapid and energetic action. It has no effect 
until it enters the duodenum, and the presence of bile appears 
to be essential for its activity. With the aid of the bile it pow- 
erfully stimulates the intestinal glands to increased secretion, 
and incidentally causes more or less hyperemia of the bowel 
and stimulation of its muscular coat. In about four hours after 
its administration a profuse watery evacuation occurs, and its 
action is attended with considerable griping. In over-doses it 
is likely to cause violent gastro-enteritis. No purgative effect 
is produced when it is injected subcutaneously or intravenously. 

Therapeutics of Scammony. 
As it is a prompt and efficient cathartic, scammony may be 
used in cases of obstinate constipation and impaction of faeces. 
On account of its violent properties, however, it is usually best 
to combine with it some carminative or less active purgative. 
It is often serviceable in the treatment of dropsical effusions 
and of cerebral affections, and is well adapted for severe cases 
of mania and hypochondriasis. For dropsy the compound 
jalap powder is more commonly employed, but when this fails 
to act recourse may be had to scammony or the compound 
scammony powder of the B. P. (scammony resin, ioo; jalap, 
75; ginger, 25). The latter preparation is also used as a vermi- 



JALAP. 703 

fuge. Scammony is efficient in clearing mucus from the intes- 
tines, and is anthelmintic against both round-worms and tape- 
worms. For children, however, this remedy is unnecessarily 
severe in the treatment of worms. Where active purgation is 
required in children, calomel and scammony may be given 
triturated with sugar of milk, or scammony may be adminis- 
tered rubbed up with milk or with syrup of rhubarb. 

JALAP. 

JALAPA. — Jalap. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Pulvis Jalapse Compositus. — Compound powder of Jalap. 
Dose, 2 gm.; 30 gr. 

2. Resina Jalapae. — Resin of Jalap. Dose, 0.125 gm. (125 
milligm.); 2 gr. 

3. Pilulse Catharticae Composite. — Compound Cathartic 
Pills. Dose, 2 pills. 

4. Pilulse Catharticae Vegetables. — Vegetable Cathartic 
Pills. Dose, 2 pills. 

Unofficial Preparation. 
Extractum Jalapae (U. S. P., 1890). — Extract of Jalap. 
Dose, .12 to .50 gm.; 2 to 8 gr. 

Action of Jalap. 

External. — It causes pain and irritation when applied to the 
nostrils in fine powder. 

Internal. — The action of jalap is very much the same as that 
of scammony, but it is somewhat less powerful and produces 
rather less colic, while it promotes even greater intestinal 
secretion. It has also been credited by some observers with 
diuretic properties. Jalapin administered by the mouth cannot 
be detected in the faeces or urine, and is therefore supposed to 
undergo complete or partial oxidation in the body. 



704 • PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Jalap. 
Jalap is occasionally employed for severe constipation, and 
an old prescription consists of equal parts of powdered jalap 
and calomel, well triturated. The dose is from .30 to .60 gm. ; 
5 to 10 gr. This is known as Rush's thunderbolt. Curiously 
enough, it does not gripe. The principal use of jalap is in the 
treatment of all forms of dropsy, and particularly that from 
Bright's disease. For this purpose the compound powder, 
which produces abundant watery evacuations, is commonly 
employed, and while the diuresis which also is frequently ob- 
served after its administration may possibly be due in a small 
measure to the effect upon the kidney of the jalap itself, the 
action of the potassium bitartrate and the relief of the engorge- 
ment of renal vessels resulting from the drain of fluid from the 
intestinal vessels would seem to be important factors in the 
augmentation of the urine. In order to enhance the diuretic 
effect, some clinicians are in the habit of prescribing an addi- 
tional amount of the potassium salt with each dose of compound 
jalap powder. For renal dropsy, and to avert the dangers of 
uraemia, it is customary to aid and supplement the action of the 
powder by the more or less frequent use of vapor baths. Jalap 
should not be employed for too long a time continuously, since 
it may occasion a form of gastro-enteritis and, in addition, may 
favor cardiac weakness. It is sometimes given in the begin- 
ning of inflammations and fevers or other acute diseases where 
an efficient cathartic is required, and is also found of service 
in various forms of cerebral congestion. The clrug is natur- 
ally contra-indicated in all inflammatory states of the alimen- 
tary canal, and large doses of it should not be given if the 
intestinal mucous membrane is liable to inflame easily. 

GAMBOGE. 
CAMBOGIA. — Gamboge. Dose, 0.125 gm. (125 milligm.) ; 2 gr. 

Preparation. 
Pilulae Catharticae Composite. — Compound Cathartic Pills. 
Dose, 2 pills. 



COLOCYNTH. fO$ 

Action of Gamboge. 

Gamboge belongs to the class of drastic or hydragogue ca- 
thartics, and is violent in its action, causing marked irritation 
of the alimentary canal, energetic peristalsis, with considerable 
griping, and greatly augmented intestinal secretion. It owes its 
activity to gambogic acid, which, however, is insoluble, and 
seldom acts unless it is accompanied with the inert bodies of 
the crude drug. Most of it escapes unaltered in the stools, but 
some is absorbed, and small and repeated doses are slightly 
diuretic. It colors the urine yellow. 

Therapeutics of Gamboge. 

As its action is somewhat uncertain, and is so violent and 
apt to cause severe colic when it does take place, gamboge is 
not often prescribed, except as the official pill into which it 
enters (Pilulse Catharticae Compositse). Even the gum-resin, 
on account of its solubility, is irritant to the stomach, so that 
the drug should always be used in pill form. It should also 
always be administered in combination with other remedies. 
It is quite an efficient anthelmintic, and is occasionally given 
with other agents of this class. 

COLOCYNTH. 

COLOCYNTHIS.— Colocynth. (Bitter Apple. Bitter Gourd. Bitter 
Cucumber.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Extractum Colocynthidis. — Extract of Colocynth. Dose, 
0.030 gm. (30 milligm.) ; y 2 S 1 - 

2. Extractum Colocynthidis Compositum.— Compound Ex- 
tract of Colocynth. Dose, 0.500 gm. (500 milligm.) ; iy 2 £?• 

3. Pilulae Catharticae Composite. — Compound Cathartic 
Pills. Dose, 2 pills. 

4. Pilulae Catharticae Vegetabiles. — Vegetable Cathartic 
Pills. Dose, 2 pills, 

46 



706 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparations. 

Tinctura Colocynthidis. — Tincture of Colocynth. Dose, .12 
to 4.00 c.c; 2 TTL to 1 fl. dr. 

Citrullinum.— Citrullin. Dose, .01 to .30 gin.; y 6 to 5 gr. 

Colocynthinum.— Colcynthin. Dose, .01 to .30 gm.; y 6 to 
5 gr. 

Action of Colocynth. 

External. — Colocynthin is irritant to mucous membranes, 
especially those of the eye, nose and throat. 

Internal. — The action of colocynth varies in accordance with 
the amount given and the mode of administration. In small 
doses it acts as a simple bitter, increasing appetite and gastric 
secretion. In larger doses it is a powerful intestinal stimulant, 
augmenting the biliary and intestinal secretions, and accelerat- 
ing the movements of both the large and small intestine. It 
occasions considerable griping pain, but the amount of colic 
does not seem to be entirely dependent upon the quantity taken, 
as even small doses may be followed by much discomfort if 
the drug is given alone. It produces abundant watery passages, 
and if the dose is excessive may set up enteritis, with bloody 
stools. Toxic symptoms are not infrequently met with from 
the use of colocynth, as it is one of the drugs commonly em- 
ployed for the purpose of producing abortion. It appears to 
have a distinct diuretic action, for colocynthin is stated to excite 
renal irritation or inflammation when it is given either hypo- 
dermatically or by the mouth, and even when the powder is 
inhaled during its manufacture. This glucoside not only 
purges when swallowed, but also when administered subcu- 
taneously or by intravenous injection, a result probably due to 
its excretion into the intestine, though it has been suggested 
that this and some of the other purgative principles may have 
a specific action quite apart from their irritant effects. Ap- 
plied to the skin of the abdomen, colocynth causes intestinal 
pain and some purgation, 



COLOCYNTH. JOJ 

Therapeutics of Colocynth. 
Colocynth is perhaps the most generally useful of the drastic 
cathartics, but it is of great importance that it should be admin- 
istered in carefully regulated doses and properly combined with 
other remedies. On account of the griping to which it gives 
rise it should never be given by itself, but a proper mode of em- 
ployment renders its effects almost comparable to those of sim- 
ple purgatives. The violence of its action may be moderated to 
a considerable degree by its administration with aromatic sub- 
stances or with intestinal sedatives such as belladonna or hyos- 
cyamus, as in the colocynth and hyoscyamus pill (B. P.: Com- 
pound colocynth pill, 2 ; extract of hyoscyamus, 1 ) . Compound 
colocynth pill consists of colocynth pulp, 1 ; Barbadoes aloes, 
2 ; resin of scammony, 2 ; potassium sulphate, l /± \ oil of cloves, 
Y^ ; water, q. s. The compound extract is a safe, effective, and 
not unpleasant preparation for the relief of constipation, and 
the compound cathartic pill is also a very serviceable combina- 
tion. This pill is sometimes made extemporaneously with podo- 
phyllin in the place of calomel. Some prefer the official veg- 
etable cathartic pill. For some cases of habitual constipation 
the compound extract of colocynth, combined with the ex- 
tracts of belladonna and physostigma, seems to answer very 
well. In cerebral congestion the preparations of colocynth 
are employed for their revulsive effect. Hypochondriasis and 
melancholia, when associated with sluggishness of the large 
intestine and faecal accumulations, are benefited by colocynth, 
as by other hydragogue cathartics. Notwithstanding its diur- 
etic action, even in the condition of health, colocynth is not so 
generally serviceable in the treatment of dropsy as jalap, al- 
though it is more or less used. Minute doses of a tincture of 
colocynth (not official) have proved efficient, it is said, in colic, 
sciatica, ovarian and other neuralgias, and for relieving the 
pain of glaucoma. Like other remedies of its class, colocynth 
is contra-indicated in inflammatory states of the intestinal canal. 
It is often stated that colocynth is unsafe during the existence 
of pregnancy, but there seems to be no good reason for this 



708 PHARMACOLOGY AND THERAPEUTICS. 

assertion, provided the remedy be administered with due cau- 
tion. Some of the most eminent obstetricians are in the habit 
of prescribing it when required, often with hyoscyamus and 
nux vomica. Colocynth in combination with colchicum is found 
in some popular remedies for gout. 

Both citrullin and colocynthin are occasionally used in medi- 
cine, particularly in the form of suppositories or enemata. The 
former is stated to be of value in hernia when strangulation is 
threatened. Colocynthin, in doses of .01 to .03 gm. (-J to T /z 
gr.), dissolved in glycerin and administered in a small enema 
consisting of not more than from one to three teaspoonfuls of 
the fluid, has been found to be a very reliable purgative, acting 
in from half an hour to two hours. Its action is attributed to 
absorption from the rectum. 

ELATERIN. 

Unofficial Preparation. 

Elaterium (B. P.). — Elaterium. Dose, .005 to .03 gm.; T \ 
to 14 gr. 

ELATERINUM.— Elaterin. Dose, 0.005 gm. (5 milligm.) ; T \ gr. 

Preparation. 
Trituratio Elaterini. — Trituration of Elaterin. Dose, 0=030 
gm. (30 milligm.); y 2 gr. 

Action of Elaterin. 

External. — Elaterium is a marked local irritant. It is stated 
to cause ulcerations upon the fingers of those who handle the 
fruit and prepare the drug for the market. 

Internal. — The action of elaterin closely resembles that of 
colocynth, but is much more energetic, and it is regarded as 
the most powerful hydragogue cathartic known. The drain of 
fluid which it induces even in medicinal doses is so profuse 
that its use is commonly attended with considerable exhaustion 
and prostration. When externally applied, it is said, as well 



ELATERIN. 7O9 

as when it is injected into the circulation, it also produces a 
purgative effect. If given in properly regulated amount, it 
occasions comparatively little pain or irritation, notwithstand- 
ing the very free catharsis caused. In small doses by the 
mouth it increases the secretion of saliva and promotes appe- 
tite. 

Therapeutics of Elaterin. 

On account of the violence of its action, elaterin is not 
adapted to cases of ordinary constipation. It is the most effi- 
cient of the hydragogue cathartics in general dropsy or in 
ascites, and while there appears to be no authority for the 
claim that it is capable of increasing the intestinal elimination 
of urea, its practical value in uraemia has been demonstrated 
by clinical experience. The great drawback to its use is the 
depression resulting from it, and hence great care should be 
exercised not to administer it in too large doses, and also to 
support the strength of the patient by appropriate measures 
when it is employed. Almost always it may be advantageously 
followed by alcoholic stimulants. It ought never to be given 
in cases of marked exhaustion, and its injudicious use in the 
later stages of dropsical affections may induce fatal collapse. 
It should always be given with the greatest caution, if at all, in 
disease of the heart, but under proper restrictions it may be 
employed for the effusion in pericarditis, as well as in pleurisy. 
In cerebral congestions or effusions and in other affections of 
the brain it is valuable as a derivative. Elaterin has been em- 
ployed in various diseases for the purpose of depletion, but to 
accomplish this the salines are usually preferable. Especially 
is this the case if there is present any gastro-intestinal irrita- 
tion or inflammation, in all instances of which, it need scarcely 
be said, elaterin is contra-indicated. Clutterbuck's elaterium, 
the dose of which is .008 gm. ( l /g gr.) has been used, because 
of the confidence reposed in its reliability, to a considerable 
extent in uraemia and puerperal eclampsia. 



7 TO PHARMACOLOGY AND THERAPEUTICS. 

BRYONIA. 

Unofficial Preparations. 

Bryonia (U. S. P., 1890).— Bryonia. (Bryony.) Dose, 0.60 
to 4.00 gm.; 10 to 60 gr. 

Tinctura Bryoniae (U. S. P., 1890). — Tincture of Bryonia. 
Dose, 8.0 to 15.0 c.c; 2 to 4 fl. dr. 

Action of Bryonia. 
Bryonia is an active hydragogue cathartic. 

Therapeutics of Bryonia. 
It was formerly much employed, but has been superseded by 
jalap. 

CROTON OIL. 
OLEUM TIGLIL— Croton Oil. Dose, 0.05 c.c; 1 ni. 

Action of Croton Oil. 

External. — Croton oil is an irritant of extraordinary power. 
A single drop applied to the skin causes pain, hyperemia and 
prompt vesication. The vesicles thus formed rapidly undergo 
pustulation, while the surrounding tissue becomes inflamed and 
cedematous. The pustules may be umbilicated, but differ from 
variolous pustules in that they vary greatly in their size. It 
has now been determined that the subcutaneous injection of 
croton oil, provided that it contains free acid, is capable of 
causing the formation of pus without the presence of microbes, 
which was formerly thought by many to be necessary for such 
action. 

Internal. — On the mucous membrane of the mouth, fauces, 
oesophagus and stomach croton oil exerts its irritant action, as 
upon the skin, but it is found that if the free acid in it is 
removed, this irritant effect will be prevented, while the oil 
will simply cause purgation in consequence of its saponifica- 
tion by the intestinal juices. Under these circumstances it is 
quite bland, and can only be distinguished from castor oil by 
its more energetic purgative action. Ordinarily croton oil is 



CROTON OIL. 711 

such a powerful irritant poison that except in the smallest doses 
it produces marked gastro-enteritis, with nausea and vomiting, 
severe abdominal pain, violent purging, with bloody stools, col- 
lapse and death. A drop of it will cause considerable colic and 
in the course of one or two hours an evacuation of the bowels. 
This is likely to be followed by others, the passages becoming 
more and more fluid. At the same time there are produced 
hyperemia of the gastro-intestinal tract, increase of secretion, 
and probably increased peristalsis. Whether the latter is due 
simply to the irritation or to some action of the drug exerted 
after absorption is undetermined, but the other effects are at- 
tributable to the local action of the oil. As to what becomes of 
croton oil in the body nothing is known with positiveness, but 
it is thought probable that part of it is excreted into the large 
intestine. Applied to the skin, the oil may cause free purga- 
tion. The toxalbumin, Crotin, which is found in the Croton 
Tiglium, but which does not pass into the oil, resembles that 
of the castor oil bean (Ricin), but is considerably less poi- 
sonous. 

Therapeutics of Croton Oil. 

External. — Croton oil was formerly employed to produce 
counter-irritation, especially in diseases of the chest and of the 
joints, but is not often used for this purpose now, at least in 
an undiluted state, as in many instances permanent cicatrices 
are left as the result of the suppuration caused. Corson's paint 
is a 5 to 10 per cent, solution of croton oil in ether, to which 
a small quantity of tincture of iodine is added to color it ; while 
the liniment of the B. P. consists of 15 per cent, of the oil in 
equal parts of alcohol and oil of cajuput. .30 c.c. (15 ^l) of 
this liniment in 30 c.c. (1 fl. oz.) of olive oil may be used as a 
stimulant application in alopecia. In very obstinate cases of 
ringworm, which have resisted other remedies, croton oil is 
sometimes applied to a spot about the size of a dime. It should 
never be used for such purposes in delicate children. 

Internal. — The chief advantages of croton oil are its rapid 
action as a drastic cathartic and the smallness of the dose 



712 PHARMACOLOGY AND THERAPEUTICS. 

required. It is therefore of great value for patients who are 
unconscious or maniacal, and it is used to a considerable ex- 
tent in cerebral apoplexy, uraemia and puerperal eclampsia. As 
a revulsive in cerebral congestion it may be of service by in- 
creasing vascular dilatation in the bowel, and thus lowering the 
intra-cranial blood-pressure. By some authorities it is consid- 
ered the one cathartic to employ when it is desired to revulse 
by the intestines. It is unsuitable for the treatment of dropsy 
or of other conditions requiring frequency of administration, 
as the action may be followed by considerable irritation. In 
obstinate constipation when there is no organic intestinal ob- 
struction a dose of croton oil often acts very happily. Thus, 
it is appropriate in cases of faecal impaction, without inflamma- 
tory symptoms, and the constipation due to lead poisoning may 
not infrequently be overcome by it after less energetic cathar- 
tics have failed. It is contra-indicated in all very feeble per- 
sons, in pregnant women, and in patients suffering from haemor- 
rhoids, peritonitis, or affections of the stomach or bowels. As 
a rule, it should be avoided in children, but occasionally it may 
be called for in them. As washing with alcohol removes the 
acidity without impairing the purgative effect of the oil, a prep- 
aration so treated is the best for this class of subjects, and it 
may be administered rubbed up with sugar of milk. The un- 
pleasant effects of croton oil may be modified by combining it 
with other remedies, as the compound extract of colocynth and 
extract of belladonna, and if in any exceptional case there should 
seem to be sufficient reasons for giving it continuously for a 
short period, it would certainly be advisable to employ it in this 
way. The treatment of poisoning by croton oil is the same as 
that for gastro-enteritis from other causes. Fortunately, when 
an over-dose is swallowed, vomiting is usually very promptly ex- 
cited, and hence very large quantities have been taken without 
producing a fatal result. In case free emesis has not been 
caused by the drug the first step in the treatment would of 
course be to evacuate the stomach. 



COLCHICUM. 713 

COLCHICUM. 

COLCHICI CORMUS (Colchici Radix, U. S. P., 1890).— Colchicum 
Corm. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparation. 
Extractum Colchici Cormi. — Extract of Colchicum Corm. 
Dose, 0.065 gm. (65 milligm.); 1 gr. 

COLCHICI SEMEN.— Colchicum Seed. Dose, 0.200 gm. (200 mil- 
ligm.) ; 3 gr. 

Preparations. 

1. Fluidextractum Colchici Seminis. — Fluidextract of Col- 
chicum Seed. Dose, 0.2 C.C.; 3 TT\,. 

2. Tinctura Colchici Seminis. — Tincture of Colchicum 
Seed. Dose, 2 c.c; 30 TT\.- 

3. Vinum Colchici Seminis. — Wine of Colchicum Seed. 
Dose, 2 c.c; 30 TO,. 

COLCHICINA.— Colchicine. Dose, 0.0005 gm. (0.5 milligm.); 

T28 S 1, 

Unofficial Preparations of Colchicum. 

Extractum Colchicis Radicis Fluidum (U. S. P., 1890). — 
Fluidextract of Colchicum Root. Dose, .12 to .50 C.C.; 2 to 8 Vl\,. 

Vinum Colchici Radicis (U. S. P., 1890). — Wine of Colchicum 
Root. Dose, 0.30 to 1 c.c; 5 to 15 TT\. 

Colchicine Salicylas. — Colchicine Salicylate. (Colchisal.) 
Dose, 0.0006 gm.; T ^ gr. 

Action of Colchicum. 

External. — Colchicum is a decided local irritant, causing red- 
ness and smarting when applied to the skin, while the dust, 
when inhaled, excites sneezing and conjunctival hyperemia, 
with a burning sensation in the mouth and throat. 

Internal. Gastro-intestinal Tract. — In the great majority of 
instances moderate doses of colchicum give rise to no appre- 
ciable effect. In some individuals, however, there is produced 
after a time a feeling of malaise, with discomfort in the stom- 
ach and bowels, followed by some nausea and diarrhcea. It 
may also have the effect of slightly increasing the biliary secre- 



714 PHARMACOLOGY AND THERAPEUTICS. 

tion. In large amounts it causes salivation and nausea, with 
violent vomiting and purging, and afterwards a condition of 
depression, apathy and collapse; and the same effects are pro- 
duced by the intravenous injection of colchicine. Several 
hours elapse after the administration of the drug before these 
symptoms are elicited, and the reason for this is stated to be 
that it is not the colchicine itself which produces them, but an 
oxidation product, oxydicolchicine, which is formed from it in 
the mammalian organism. In man, at least, it would appear 
that the gastro-intestinal irritation is not altogether an inflam- 
matory action, since the intestine may appear quite normal 
after death, and there is seldom more than a simple catarrh of 
the duodenum. When ecchymoses, etc., have been found, they 
have been ascribed to the mechanical effects of the extremely 
energetic peristalsis occasioned. The explanation of the symp- 
toms which has been offered is that there appears to be an 
increased irritability of the intestinal tract, so that normal im- 
pulses, which ordinarily keep up a moderate peristalsis, now 
produce a very violent one. In mammalian animals poisoned 
with colchicine, however, it is stated that the alimentary canal 
presents all the appearances of acute gastro-enteritis ; so that 
this explanation would seem somewhat inadequate. The 
amount of the drug ingested appears to have little influence on 
the duration of the preliminary stage of quiescence. 

Circulation and Respiration. — In animals the heart's action 
and blood-pressure remain unaffected, and while in man the 
pulse may become small, rapid and thready, this is no doubt 
simply the result of the collapse. The respiration is found to 
be slow, though deep and full at first. Later it becomes shal- 
low, and death is due to failure of the respiratory centre, the 
heart continuing to beat for some time afterward. 

Nervous System and Muscles. — The action on the central 
nervous system is almost purely depressant, but it is believed 
that the nervous symptoms caused are probably secondary to 
the effect upon the abdominal organs, rather than due to any 
direct central action. In the case of mammalian animals poi- 



COLCHICUM. 715 

« 

soned with colchicine when the collapse sets in the movements 
are found to become slow and difficult, more especially in the 
posterior extremities, which are eventually rendered completely 
motionless. The paralysis then extends upwards until the 
movements of the fore limbs and respiratory muscles are in- 
volved, when death occurs from asphyxia. In man the con- 
sciousness and intelligence as a rule remain unimpaired, though 
there is generally some giddiness. In exceptional instances 
there is more or less confusion, and even delirium may precede 
the collapse. In the frog colchicine is said to have little or no 
effect, but if the solution be exposed for some time to the air, 
so that oxydicolchicine is formed, it is found to cause a pro- 
longation of the muscular contraction similar to that seen after 
veratrine, and eventually a tetanus resembling that due to 
strychnine. This oxidation product does not seem to be capa- 
ble of formation within the frog's system, as in that of a warm- 
blooded animal. 

Kidneys. — In some instances the urine is slightly increased, 
while in others complete anuria, lasting for many hours, is pro- 
duced. According to the latest and most reliable researches, 
it has been found that small quantities of colchicine increase 
the amount, and both the urea and uric acid, as well as the 
fluid, while under larger doses the fluid is diminished, the urea 
and uric acid being less affected than with the smaller ones. 
In animals, it is stated, bloody urine sometimes results from 
the colchicine. 

Therapeutics of Colchicum. 
Colchicum has long been used empirically in the treatment 
of gout, but it is not now as universally employed in this dis- 
ease as formerly. Authorities differ as to its value, and some 
physicians have denied that it has any beneficial effect. It has 
been shown, as has been mentioned, that it increases the elim- 
ination of uric acid, but unfortunately for the explanation of 
its remedial action on rational grounds, it seems now to be 
established that gout is not due to a deficient excretion of this 
agent. As the pathology of the disease, therefore, remains 



yi6 PHARMACOLOGY AND THERAPEUTICS. 

entirely uncertain, it can only, like other medicines, be used in 
its treatment in a purely empirical manner; but it appears to 
be a fact that in a considerable proportion of cases, at least, 
its administration is attended with more or less decided benefit. 
In these, if given in suitable quantities during the attack, it 
markedly relieves the pain, while in smaller doses between the 
attacks it seems to lessen their severity. In certain instances 
also where headache, neuralgia, dyspepsia, neuritis, eczema, 
conjunctivitis, bronchitis and various other ailments recur in 
gouty subjects, it is found useful. According to some who 
consider the drug almost a specific in acute gout, provided that 
it be pushed until it causes a slight griping or laxity of the 
bowels, it is the opinion that it not only does not have any 
marked effect in preventing attacks, but that it often seems to 
hasten their onset. The active principle, colchicine, is believed 
by some to be more successful in gout than any form of the 
crude drug. The preparation known as colchicine salicylate 
is a solution of colchicine in oil of wintergreen. Colchicum is 
used to some extent in the treatment of chronic rheumatism 
and so-called rheumatic gout, or rheumatoid arthritis, and here, 
as well as in subacute or chronic gout, it is advised that it 
should be given in conjunction with potassium iodide. In gout 
the commencement of the treatment with a purgative is usually 
advisable, and it is also a common practice to administer col- 
chicum with magnesium sulphate or carbonate. A well-known 
formula is: Extract of colchicum corm, calomel, powdered aloes, 
powdered ipecacuanha, of each .06 gm. (1 gr.), with .015 to 
.03 gm. (34 to y 2 gr.) of extract of nux vomica. The seed is 
said to be less active than the corm. To elderly persons and 
to those whose circulatory apparatus is feeble it is advised 
that colchicum should be administered with caution, or not at 
all. Moreover, some individuals exhibit an intolerance of even 
very small doses, which quickly produce intestinal irritation or 
cardiac depression. It is found that the paroxysms of gout may 
often be suppressed by large purgative doses, but experience 
has shown that this use of the drug is dangerous, as such sup- 



PHYTOLACCA. 7 I J 

pression is liable to be followed by serious internal disease, ap- 
parently due to a transfer of the gouty affection. 

TOXICOLOGY. 
In the treatment of colchicum-poisoning an emetic and a cathartic 
should be administered at once, if the stomach and bowels have not 
been freely evacuated. Large quantities of warm water may also be 
given to aid in these operations and to act on the kidneys. Tannic 
acid is a chemical antidote, forming an insoluble tannate with the alka- 
loid, and though experiments upon animals have shown that it is 
not to be relied upon, it should be thoroughly tried in large amount. 
Otherwise the treatment must be symptomatic. Opium is usually re- 
quired to relieve the pain and check vomiting and diarrhoea, and 
stimulants to counteract depression. 

PHYTOLACCA. 

PHYTOLACCA (Phytolacca Radix, U. S. P., 1890).— Phytolacca. 
(Poke Root.) Dose, (emetic) 1 gm.; 15 gr.; (alterative) 0.125 gin. 
(125 milligm.) ; 2 gr. 

Preparation. 
Fluidextr actum Phytolaccae. — Fluidextract of Phytolacca. 
Dose, (emetic) 1 C.C.; 15 Til; (alterative) 0.1 C.C.; V/ 2 TTV. 

Unofficial Preparation. 
Phytolaccae Fructus (U. S. P., 1890). — Phytolacca Fruit. 
(Poke Berry.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr. 

Action of Phytolacca. 
Phytolacca is an emeto-cathartic, acting slowly and causing 
considerable depression. In large doses it possesses also some 
narcotic properties. 

Therapeutics of Phytolacca. 
Phytolacca is used as a laxative and alterative. Recently a 
preparation made from the berries has been used to reduce adi- 
pose tissue. 



7l8 PHARMACOLOGY AND THERAPEUTICS. 

(d) Intestinal Antiseptics. 

BETANAPHTHOL. 

BETANAPHTHOL (Naphtol, U. S. P., 1890).— Betanaphthol. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 
Hydronaphthol. — Hydronaphthol. Dose, .12 to .18 gm.; 2 
to 3 gr. 

Naphthol Camphoratum. Camphorated Naphthol. 

Action of Betanaphthol. 
This substance is antiseptic and irritant. In animals, in 
large doses, it causes symptoms similar to those of phenol 
poisoning, except that the convulsions are less pronounced, 
and in the dog are not observed at all. In solution or in vapor 
it is irritant to mucous membranes, and in the course of excre- 
tion it induces pain in the bladder and urethra, with strangury, 
and hyperemia and swelling of the mucous membrane. Either 
when injected subcutaneously or absorbed from the alimentary 
canal in sufficient quantity it excites acute nephritis, with albu- 
minuria and hemoglobinuria. In man some nephritis is said 
to have been caused from its external application. 

Therapeutics of Betanaphthol. 
Betanaphthol was first introduced as an antiseptic in der- 
matological practice and used, in a 10 per cent, ointment, in 
scabies, ringworm and psoriasis; it is, however, irritating in 
eczema. It is a remedy of great value in obtaining intestinal 
antisepsis, bacteriological investigations showing that it de- 
stroys certain micro-organisms in situ when administered to the 
extent of 2.70 gm. (40 gr.) a day. As it is more or less irri- 
tating to the stomach it should be administered in keratin- 
coated pills when its action is desired in the intestine only. It is 
useful in flatulent dyspepsia, chronic gastric or intestinal ca- 
tarrh, and dilatation of the stomach. Good results have also 
been reported from its employment in typhoid fever, tubercu- 
lous ulceration of the bowels, scarlatina, diphtheria and erysipe- 






ASAPROL. 719 

las. Fatal inflammation of the kidneys has resulted in some 
instances where it has been used in large quantities. 

Hydronaphthol (not official) occurs in glistening, micaceous 
scales and is sparingly soluble in water, but freely soluble in 
alcohol, ether, chloroform, glycerin and oils. It has been rec- 
ommended for antiseptic purposes generally, and it is beneficial 
as an external application in many skin diseases. It has been 
shown, however, to exist only as an impure form of beta- 
naphthol. 

Camphorated Naphthol (not official), which is prepared by 
carefully heating one part of naphthol with two of camphor, is 
a homogeneous, oily fluid which is insoluble in water and read- 
ily decomposes on exposure to light and air. It is used as a 
parenchymatous injection, either undiluted or in olive oil, in 
doses of .12 to .30 c.c. (2 to 5 1*1). It is reported to have been 
extensively employed in the irrigation of joints, bony cavities, 
tendinous sheaths, cold abscesses in the pleural and uterine 
cavities, and in tuberculosis of the bladder; all of which parts 
seemed to bear the undiluted fluid well. It has also been sub- 
cutaneously injected, with alleged good results, in tuberculous 
adenitis and tuberculosis of the testis. It is considered by some 
practitioners to be superior to all other remedies for prevent- 
ing suppuration in acute tonsillitis. 

ASAPROL. 

Unofficial Preparation. 

Asaprol. — Asaprol. (Calcium betanaphthol alpha-monosui- 
phonate.) Dose, 1 to 4 gm.; 15 to 60 gr. 

Action of Asaprol. 
Asaprol is a useful, soluble and safe antiseptic. 

Therapeutics of Asaprol. 
It is valuable in epidemic influenza, relieving the pain and 
reducing the fever, not giving rise to prostration or inter- 



720 PHARMACOLOGY AND THERAPEUTICS. 

ference with the heart or respiration. In atonic dyspepsia, 
when fermentation alternates with acid eructations, it has 
achieved brilliant results. Since it is not irritating to the ali- 
mentary mucous membranes, it can advantageously replace 
betanaphthol. In chronic rheumatism it will relieve the pain of 
an acute exacerbation. In acute rheumatism, although it does 
not present the disadvantages of the salicylates, it is not so use- 
ful, nor so uniformly successful. It has also been employed 
in typhoid fever. 

NAPHTHALENE. 

NAPHTHALENTJM (Naphtalinum, U. S. P., 1890).— Naphthalene. 
(Naphthalin.) Dose, 0.125 gm. (125 milligm. ) ; 2 gr. 

Action of Naphthalene. 
Naphthalene is antiseptic, antifermentative, disinfectant and 
deodorant. Since it is not absorbed by the system, it acts only 
upon the mucous membrane of the bowels. 

Therapeutics of Naphthalene. 

It is a true intestinal antiseptic, and is of great value in 
dysentery and in catarrhal, typhoid and tuberculous diarrhoea, 
where it markedly lessens or entirely abolishes the foetor of the 
movements. It has also been used as a vermifuge (dose, .20 
to .40 gm. ; 3 to 6 gr.). Success in the treatment of dysentery 
usually requires a daily dose of from 4 to 8 gm: (1 to 2 dr.), 
best administered in starch wafers with oil of bergamot. 

Externally, naphthalene is a useful antiseptic for ulcers, can- 
cers and pus cavities, and can be employed in watery emulsion, 
in alcoholic solution, or in a dry form. In ointments, in which 
it is sometimes combined with calomel, it has been used with 
advantage for chancres, chancroids, syphilitic ulcers, sloughing 
wounds, psoriasis and chronic eczema. Naphthalene is well 
suited for the disinfection of urinals, since it is so sparingly 
soluble and very cheap. It is also in common use for preserv- 
ing furs and woollen goods from moths. 






SALICYLIC ACID. J2\ 

RESORCINOL. 

Resorcinol (Resorcinum, U. S. P., 1890). — Resorcinol. (Resorcin.) 
Dose, 0.125 gm. (125 milligm.) ; 2 gr. 

Action of Resorcinol. 

Resorcinol was originally introduced as an antipyretic, but 
is now seldom employed for this purpose, as the necessarily 
large doses are too depressant to the heart. It is powerfully 
antiseptic. Dark-colored urine, often described as smoky, is 
sometimes seen after large doses. 

Therapeutics of Resorcinol. 

A solution of resorcinol in glycerin, 1 to 4, is a good appli- 
cation for removing epidermic scales in chronic skin diseases 
and also the scales in seborrhcea sicca of the scalp; here it 
doubtless inhibits the action of the bacteria which may be the 
cause of dandruff. A lotion of resorcinol, 1 ; ether, 1 ; castor 
oil, 1; eau de Cologne, 10; alcohol (90 per cent.), 35, may be 
used both for dandruff and alopecia. A 5 per cent, solution 
of resorcinol is an excellent antiseptic injection for the bladder 
in cystitis. This remedy is of great value in fermentative dys- 
pepsia when administered, well diluted, one hour after the in- 
gestion of food. 

SALICYLIC ACID. 

SALICINTJM.— Salicin. Dose, 1 gm.; 15 gr. 

ACIDUM SALICYLICUM.— Salicylic Acid. Dose, 0.500 gm.; 
7V 2 gr. 

SODII SALICYLAS.— Sodium Salicylate. Dose, 1 gm.; 15 gr. 

LITHII SALICYLAS.— Lithium Salicylate. Dose, 1 gm.; 15 gr. 

AMMONTE SALICYLAS.— Ammonium Salicylate. Dose, 0.250 gm. 
(250 milligm.); 4 gr. 

STRONTII SALICYLAS.— Strontium Salicylate. Dose, 1 gm.; 
15 gr. 

Unofficial Preparation. 

Aspirinum. — Aspirin. (Acetyl Salicylic Acid.) Dose, 0.30 to 
4 gm.; 5 to 60 gr. 

7 



722 PHARMACOLOGY AND THERAPEUTICS. 

Action of Salicin, Salicylic Acid, and of Sodium, Lithium, 
Ammonium and Strontium Salicylates. 

External. — Salicylic acid is somewhat more powerfully anti- 
septic than phenol, but its salts are less strongly antisep- 
tic. Salicin, it is stated, has no antiseptic properties unless 
decomposed into its constituents. Applied to the skin, salicylic 
acid has the effect of softening the epidermis and also of dimin- 
ishing perspiration. It is irritant to mucous membranes and 
abraded surfaces, and its continued application in concentrated 
form may have some destructive action on the tissues. When 
inhaled or applied to the fauces, it excites sneezing and cough- 
ing. 

Internal. Alimentary Tract. — When swallowed in powder 
salicylic acid causes irritation, and sometimes soreness, of the 
mouth and throat. In the stomach it is also irritant, and is 
apt to cause pain, nausea and vomiting, with more or less con- 
gestion. In some instances even erosion of the mucous mem- 
brane is produced. In dilute solution, however, it has no such 
effect. Salicin is a bitter tonic, instead of an irritant to the 
stomach, though after absorption its action is similar to that 
of the acid. The sodium and lithium salts are also much less 
irritating than salicylic acid. In the body salicin, when given 
by the mouth, is decomposed into glucose and saligenin 
(C 7 H 8 2 ), and this process no doubt takes place in the intes- 
tine, for when it is injected into the circulation it is chiefly 
excreted unchanged. Saligenin is further decomposed into 
salicylic acid, salicylous acid or salicylic aldehyde (C 7 H 6 0,), 
and salicyluric acid (HC 9 H 8 N0 4 ). 

Liver. — Salicylic acid and the salicylates increase the biliary 
secretion, through some specific action, it is thought, on the 
liver cells, and they are probably the strongest cholagogues 
known. Both the amount of bile and the solids are augmented, 
and in one case of biliary fistula it was found that the concen- 
tration of the secretion was increased, the solids being aug- 
mented in greater proportion than the fluid. In dogs, however, 



SALICYLIC ACID. 723 

the bile is stated to become more liquid, and to contain less than 
the usual amount of solid constituents. 

Heart and Circulation. — In animals small doses intrave-, 
nously injected have the effect of accelerating the heart, prob- 
ably from a direct action on the cardiac muscle, while the 
blood-pressure is increased from stimulation of the vasocon- 
strictor centre in the medulla. Very large doses produce weak- 
ness and slowness of the heart, which becomes dilated, and a 
fall in the blood-pressure. The lowered pressure is due prin- 
cipally to the cardiac action of the drug, and to a less extent, 
it may be, to depression of the vaso-constrictor centre. It has 
been shown by sphygmographic tracings that in man full doses 
of sodium salicylate (5 gm. — yy gr. — in two doses of 2.5 gm. — 
38^ gr. each, given in water with an interval of one hour 
between the doses) possess rather a raising than a lowering 
action upon the intra-arterial blood-pressure and the frequency 
of the pulse. In febrile cases, some of which were rheumatic, 
the continued use of the drug in doses of 2 to 4.5 gm. (30 to 
7° & r -) P er diem did not produce any appreciable depression. 
The depressing effect of salicylates upon the heart which has 
sometimes been observed clinically may, it is thought likely. 
have been due to impurities in the drug, since it has been shown 
that orthocreosotic acid is a powerful cardiac poison, and that 
artificial salicylic acid and its sodium salt, containing creosotic 
acids, were fatal to rabbits, while much larger doses of the 
pure acid had no injurious effects. 

Blood. — It is now known that salicylic acid, which is readily 
absorbed, exists in the blood as the salicylates of the alkalies. 
By some observers it has been found to be taken up from the 
blood by the synovial membranes and rapidly excreted into the 
cavities of the joints. If this is the case, it would thus be 
capable of exercising a specific action in acute rheumatism. 
The number of leucocytes in the blood is increased. 

Respiration. — In man, acceleration of the respiration and 
dyspnoea are occasionally observed, and such results have been 
attributed to a central action. In animals the respiration is 



724 PHARMACOLOGY AND THERAPEUTICS. 

first quickened to some extent, and then slowed; showing prob- 
ably that the respiratory centre is at first stimulated and then 
depressed. Very large doses eventually paralyze the respira- 
tion, and death is apparently due to this cause, the heart con- 
tinuing to beat for some time afterwards. 

Temperature. — Medicinal doses have no influence on the nor- 
mal temperature. Very large quantities, by producing a col- 
lapse-like condition, may bring about some reduction in it. In 
fever patients, however, a distinctly antipyretic action is often 
observed, though the fall in temperature is usually smaller and 
of shorter duration than that caused by drugs of the acetanilide 
series. This action has been attributed to dilatation of the 
cutaneous vessels and an increase in the output of heat. Sali- 
cylic acid and salicin are antiperiodic. 

Skin. — It has been shown by plethysmographic measurements 
that the vessels of the skin are dilated by salicylic acid in the 
same way as by the antipyretics, and this action is supposed 
to be due to excitation of the vaso-dilator centres in the medulla 
which control the cutaneous areas. Probably the reason that 
such dilatation does not cause any reduction of the normal tem- 
perature is that it is counter-balanced by an increased heat 
formation. In some individuals skin eruptions of various 
character (possibly due in great measure to the dilation of the 
cutaneous vessels) are observed, but they occur less frequently 
than under the use of the antipyretics. The perspiration which 
so often follows the administration of salicylic acid and its salts 
is due, it is thought, rather to increased activity of the sweat 
centres than to the vascular dilation. 

Nervous System. — Except in cases where a special idiosyn- 
crasy is present, the effects of salicylic acid on the central ner- 
vous system are unimportant. In animals no marked depres- 
sion appears to be produced except in the medulla oblongata. 
It is true that convulsions sometimes make their appearance 
before death, but they are believed to be due to the asphyxia 
caused rather than to any direct effect of the drug. In the 
medulla there is apparently at first a stimulation and subse- 



SALICYLIC ACID. 725 

quently a depression of the respiratory, the vaso-constrictor, 
and, probably, the vaso-dilator centres. 

Kidneys. — Salicylic acid has a moderate diuretic action, prob- 
ably increasing the urinary secretion by its irritating effect on 
the renal epithelium. The increased formation of urea may 
also be a factor in the diuresis. Nephritis, with albuminuria and 
hematuria, has occasionally been observed. An increase of 10 to 
12 per cent, in the nitrogen and sulphur of the urine is caused by 
salicylic acid, indicating a considerably augmented decomposition 
of the proteids of the body. There is also a very marked in- 
crease in the excretion of uric acid, different observers esti- 
mating this at from 30 to 100 per cent. Salicylic acid first 
appears in the urine in from ten to thirty minutes after inges- 
tion. It is excreted by the kidneys to some extent unchanged, 
but for the most part in combination with glycocoll. The com- 
pound thus formed, salicyluric acid, is analogous to hippuric 
acid. It reduces Fehling's solution, and has been mistaken for 
sugar. The color of the urine is often dark or' greenish in 
consequence of the presence of pyrocatechin or indican, or 
both. The urine of persons taking salicylic acid gives a purple 
tint with ferric chloride. Under the use of salicylic prepara- 
tions the normal acidity of the urine is increased, and alkaline 
urine may become acid. It acts as an antiseptic to the mucous 
membrane of the urinary tract, and will remain undecomposed 
for a considerable time after it has been passed. 

Salicylic acid does not appear to be excreted by the stomach, 
but it has been found in the milk, bile and perspiration. 

Salicylism. — In some individuals a train of symptoms ana- 
logous to those of cinchonism, and designated as salicylism, is 
produced by the use of salicylic preparations. The skin rashes 
have already been referred to. Perhaps the most frequent of 
the manifestations is deafness, generally with tinnitus aurium, 
and these disorders of hearing, as in the case of quinine, have 
been shown to depend upon congestion of the tympanum, in 
which ecchymoses and even inflammation may be found. Such 
symptoms, it is well to note, may be relieved by the administra- 



726 PHARMACOLOGY AND THERAPEUTICS. 

tion of a small amount of alcoholic stimulant fifteen minutes 
before each dose. The eye may also be affected; so that there 
may be dimness of vision, sometimes amounting to total blind- 
ness, in consequence, it is supposed, of constriction of the ocular 
vessels. Headache, with a sense of fullness, is also a common 
symptom, and this is very often associated with epistaxis. In 
some instances haemorrhages from the retina, mouth, intestine, 
kidney, or uterus likewise occur. Abortion has been repeat- 
edly observed under salicylate treatment, but, as in the case 
of quinine, it is considered an open question whether this was 
due to the remedy or the disease. If the administration of 
the drug is continued, the disturbances of the circulation of the 
brain may produce violent delirium. Nausea and vomiting 
occur, and the pulse and respiration gradually become de- 
pressed. That some at least of these untoward symptoms, as 
well as others which are occasionally met with, may be due to 
impurities present in artificial salicylic acid seems probable. 

Therapeutics of Salicin, Salicylic Acid, and of Sodium, 
Lithium and Strontium Salicylates. 
External. — For external applications salicylic acid has the 
advantages of being odorless and comparatively free from the 
danger of toxic symptoms following absorption. The ointment 
(official in B. P., 1 part of the acid to 9 of hard, and 18 of soft 
paraffin) may be used when an antiseptic and stimulating un- 
guent is called for. Other useful preparations are a collodion 
composed of salicylic acid, 1, flexible collodion, 8; a glycerin 
containing 10 per cent, of salicylic acid; and a plaster, also 10 
per cent. Strong applications of salicylic acid are very ser- 
viceable for removing excess of epidermis, as in warts or corns, 
because it softens epithelium. The acid has a peculiar action 
upon the epidermis, and especially upon the corneous layer; 
the horny cells are softened, gradually loosened, and separated 
from the corium without any inflammatory reaction. What is 
known as "green solution," consisting of salicylic acid, 11; 
extract of cannabis indica, 2; flexible collodion, 87 parts, is 



SALICYLIC ACID. 727 

often used for corns, but the tincture of hemp is of no special 
advantage and makes an unsightly stain. Strong applications 
of the acid are also employed for the destruction of such 
growths as lupus nodules. Salicylic acid may be combined with 
chalk as a dentifrice, and with chalk, talc, starch, cornmeal or 
rice flour for checking profuse or fetid perspiration of the feet 
and axillae and also the night-sweats of phthisis. This acid is 
the principal ingredient in Thiersch's solution (see p. 87), 
and a small amount of it is often added to Thompson's fluid 
(see p. 87). In gangrene or sloughing ulcer it may be ap- 
plied either in full strength or diluted, as seems advisable. 
Dressings may be saturated with an alcoholic solution and 
dried. Aqueous solutions, made by means of alcohol, act as a 
local anodyne, when applied in thrush and catarrhal stomatitis, 
allaying the burning pain of the erosions left after the vesicles 
have ruptured. Salicylic acid is used to a considerable extent 
in cutaneous diseases. On account of its germicidal activity 
it is efficacious in tinea circinata, and a solution of it in collo- 
dion is said to be a serviceable application for scabies, after the 
skin has been cleansed by a hot alkaline bath. An ointment con- 
taining it may be used to remove freckles, and for the treatment 
of chronic eczema, lupus erythematosus of the face and eyelids, 
and ulcerated lupus vulgaris. To relieve the smarting and itch- 
ing of urticaria the following powder has been recommended: 
Salicylic acid, 5; zinc oxide, 15; powdered starch, 30 parts. 

Internal. — In many cases of rheumatic fever salicylic acid 
seems to act as a specific. Under its influence the temperature 
is rapidly reduced and the swelling and pain in the joints dimin- 
ished, and it apparently has some effect in preventing the car- 
diac complications so frequently met with in this disease. In 
order to avoid gastric disturbance it should be administered 
well diluted. Sodium salicylate is frequently given on account 
of its greater solubility, in preference to the acid itself. When 
this preparation is used, care should be taken that it is made 
either from natural salicylic acid or from artificial acid known 
to be free from impurities. In a well-marked attack of the 



728 PHARMACOLOGY AND THERAPEUTICS. 

disease it is customary to give 1.20 gm. (20 gr.) every two to 
three hours for the first day, or longer if there is not a satis- 
factory abatement in the symptoms. When this has been ac- 
complished, the remedy, in the same dose, should be given 
three times a day, and continued for about ten days after the 
fever and pain have gone. Salicin, which is usually very well 
borne and is thought to be less depressant, is less certain in its 
effects, as its therapeutic activity probably depends upon its 
conversion into salicylic acid, and this process has been found 
to be a slow and imperfect one. The salicylic preparations 
are sometimes of service in chronic as well as acute rheuma- 
tism. They are of no benefit in rheumatoid arthritis. In gout 
their value is questionable, some authorities advocating their 
employment and others believing them to be entirely inefficient. 
If given at all in this disease, very large doses seem to be 
required, and even then no effect may be produced. For the 
glycosuria of patients affected with gout or goutiness they are 
distinctly useful. In many cases of migraine and sciatica the 
salicylates are of incontestible service, and their efficacy in such 
affections is explained by the action of these remedies in elim- 
inating uric acid. So far as they limit intestinal fermentation 
they are also beneficial in diabetes. Except in the case of rheu- 
matic fever they are not employed as antipyretics, as in other 
febrile conditions the temperature can be more efficiently re- 
duced, when this is desirable, by other means. In cases of 
alkaline urine and cystitis salicylic acid has sometimes been 
resorted to to alkalize the urine, but there are better remedies 
for this purpose. In the treatment of cholelithiasis, sodium 
salicylate, in association with sodium benzoate, has been found 
very useful for the conditions which tend to cause intestinal 
catarrh and thus lead to catarrh of the biliary passages. Sali- 
cin, which, like other bitters, promotes appetite and digestion, 
may be employed as a stomachic in atonic dyspepsia. It has 
also been found useful in preventing the fermentations which 
take place in the food in cases of gastro-intestinal catarrh, and 
as a remedy for the chronic diarrhoea of children. 



SALICYLIC ACID. 729 

Aspirin (not official) is acetyl salicylic acid, which occurs as 
a white, insoluble, crystalline powder, or in needles, of an agree- 
able taste. In an alkaline fluid it breaks up and sets free sali- 
cylic acid. It has been employed for acute polyarticular rheu- 
matism in the same doses as sodium salicylate, over which it is 
believed to possess the advantage of not deranging digestion. 

OLEUM BETULA. (Oleum Betulae Volatile, U. S. P., 1890.) — 
Oil of Betula. (Oil of Sweet Birch.) Dose, 1 C.C.; 15 TTL . 

OLEUM GAULTHERIA.— Oil of Gaultheria. (Oil of Winter- 
green.) Dose, 1 c.c; 15 TT\. 

Preparation. 
Spiritus Gaultheriae.— Spirit of Gaultheria. Dose, 2 c.c; 
30 TT\. 

METHYLIS SALICYLAS.— Methyl Salicylate. Dose, 1 C.C.; 
15 T\. . 

Preparation. 
Cataplasma Kaolini. — Cataplasm of Kaolin. 

Action of Oil of Betula, Oil of Wixtergreex and Methyl 
Salicylate. 
The action of these substances is the same as that of salicylic 
acid. When taken in moderate quantities, they are, like that 
acid, broken up and eliminated as salicyluric acid. It is as- 
serted that methyl salicylate, which is an ester, formed syn- 
thetically, can be produced of more uniform quality and is more 
certain and definite in its action than either of the natural oils. 

Therapeutics of Oil of Betula, Oil of Wixtergreex axd 
Methyl Salicylate. 
The uses of these drugs are the same as of salicylic acid, and 
they possess the additional advantage that they are not liable 
to contamination with impurities such as ortho- and para- 
creosotic acids ; the former of which is a powerful cardiac de- 
pressant, and both of which are found in the artificial salicylic 
acid. 



730 PHARMACOLOGY AND THERAPEUTICS. 

PHENYLIS SALICYLAS (Salol, U. S. P., 1890). Phenyl Salicy- 
late. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. 

Unofficial Preparation. 
Salol Camphoratum. — Camphorated Salol. (Salol Camphor.) 

Action of Phenyl Salicylate. 
Phenyl Salicylate, or Salol, is an antiseptic, germicide and 
antipyretic. It has little or no local action in the mouth or 
stomach, but in the intestine is decomposed by the fat-splitting 
ferment of the pancreatic juice into phenol, about 36, and sali- 
cylic acid 64, per cent. It is thought that under certain con- 
ditions some decomposition also takes place in the stomach. 
The two constituents, thus set free, are absorbed and produce 
their characteristic effects on the system. It is not generally 
toxic in therapeutic doses, but its too free use may give rise to 
the symptoms of carbolic acid poisoning. In moderate quanti- 
ties it sometimes produces the disturbances of hearing observed 
under salicylic acid, without any evidences of carbolic intoxi- 
cation. 

Therapeutics of Phenyl Salicylate. 

External. — As an antiseptic for external use it has probably 
been overrated, as it is stated to be active only when decom- 
posed by the microbes which it is designed to destroy. It has 
been used, mixed with talc (1 to 5), as a dusting powder, and 
as a dressing for wounds, burns and ulcers, as well as for ery- 
sipelas, impetigo, pustular eczema, and other cutaneous affec- 
tions. A camphorated salol is recommended in the treatment 
of suppurative otitis. 

Internal. — In rheumatic fever it is used to some extent as a 
substitute for salicylic acid. Although somewhat slower in 
action, it has the advantage of being tasteless and of producing 
no gastric irritation. Occasionally, however, the considerable 
amount of phenol freed by its decomposition has induced 
troublesome symptoms. Since the decomposition of salol takes 
place in alkaline fluids, it has been used as an intestinal anti- 



SALOPHEN. 731 

septic in acute diarrhoea, catarrh of the bile-ducts, dysen- 
tery, cholera and other diseases; also in affections of the urin- 
ary tract. For the last the following may be used : Salol, 1 ; 
almond oil, 2 ; powdered acacia, 1 ; syrup, 2 ; water, 24. The 
emulsion should be made in a warm mortar with water at 65.5 ° 
C. (150 F.). It is a remedy of very great value in the treat- 
ment of typhoid fever, for by the active disinfection of the con- 
tents of the intestine and of the ulcerations, it favors their 
healing and prevents reinfection, thus lowering temperature and 
diminishing the liability to relapse and to permanent damage to 
tissues. This is the logical treatment, because it destroys the 
cause of the symptoms at their point of origin. On account of 
the large proportion of phenol which it contains salol is more 
dangerous than the corresponding amount of salicylic acid, and 
it is especially to be used with great caution if the kidneys are 
diseased. Sometimes, in fever, on account of the lessened alka- 
linity of the intestinal contents, it is not decomposed into its 
constituents, and for that reason becomes very much less effec- 
tive. In this case an alkali should be administered at the same 
time. Salol has proved efficient in the so-called bilious form 
of sick headache and in some varieties of neuralgia, and is 
highly praised in the treatment of epidemic influenza. 

Unofficial Preparation. 
Salophenum. — Salophen (Acetylparamidophenol Salicylate). 
Dose, .30 to 1 m.; 5 to 15 gr. 

Action of Salophen. 
Salophen is regarded as possessing the medicinal virtues of 
salol, while at the same time free from its toxic qualities. In 
a warm alkaline solution it is broken up into salicylic acid and 
acetylparamidophenol, the latter being harmless. It is decom- 
posed in the intestines, even when given hypodermatically. 

Therapeutics of Salophen. 
It is used as a substitute for salicylic acid in acute rheuma- 
tism, and as an intestinal antiseptic. It is probably quite as 



732 PHARMACOLOGY AND THERAPEUTICS. 

efficient, and much safer than salol. The fact that it is taste- 
less renders it easy of administration. 

Division X. — Drugs acting on the Nervous and Muscular 

Systems. 

A. Drugs acting on the Muscles. — While many facts of inter- 
est have been ascertained in regard to this class of drugs, they 
have no practical bearing on therapeutics. Brunton's classifi- 
cation, founded on that of Kobert, is as follows: 

Class I. Irritability of muscle unaffected ; total amount of work it 
can do diminished. — The following produce this effect : Apomorphine, 
delphine, saponin, copper, zinc, and cadmium, and in large doses, anti- 
mony, arsenic, platinum, and iron. 

Class II. Both the irritability and the capacity for work diminished. 
— The following produce this effect : Potassium, lithium, ammonium, 
quinine, alcohol, hydrated chloral, and chloroform. 

Class III. Diminish the capacity for work, and make the excitability 
very irregular. — Lead, emetine, and cocaine. 

Class IV. Alter the form of the muscle curve. — Veratrine, digitalis, 
squill, and barium, strontium and calcium salts. 

Class V. Increases the excitability. — Physostigmine. 

Class VI. Increase the capacity for work. — Caffeine and theobromine. 

Small doses of strychnine and veratrine shorten the latent period ; 
large doses lengthen it. 

Dilute alkalies diminish the extensibility ; dilute acids increase it. 

B. Drugs acting on the Peripheral Endings of Motor Nerves. 

— Curare is the typical drug of this class. While many of the 
others have a special action on the motor nerve terminations in 
common with curare, in the greater number of them this action 
is more or less over-shadowed by other effects. With curare, 
however, the action is so widely distributed that it may be 
looked upon as a peculiar expression of fatigue and as a sign 
of injury to these endings. In experiments upon animals it 
can be shown by a process of exclusion that curare paralyzes 
the peripheral endings of motor nerves alone, the sensory 
nerves and the muscle-fibres being unaffected. 



DRUGS ACTING ON NERVES AND MUSCLES. 733 

Drugs paralyzing the termination of the motor nerves in muscle: 



(1) Curare. 

(2) Conium. 

(3) Belladonna (atropine). 

(4) Stramonium. 

(5) Hyoscyamus. 

(6) Scopola. 

(7) Saponin. 

(8) Sparteine. 

(9) Amyl nitrite. 



(12) Camphor. 

(13) Lobeline. 

(14) Nicotine. 

(15) Methyl-brucine. 

(16) Methyl-cinchonine. 

(17) Methyl-codeine. 

(18) Methyl-morphine. 

(19) Methyl-quinine. 

(20) Methyl-nicotine. 



(10) Diluted hydrocyanic acid. (21) Methyl-strychnine, and 

(11) Cocaine. many others. 

Curare and conium are by far the most important, but this action is 
not made use of in medicine. 

Drugs stimulating the termination of motor nerves in muscle: 



(1) Aconite. 

(2) Nicotine. 

(3) Pilocarpine. 



(4) Pyridine. 

(5) Strychnine (slightly). 



It is possible that some of the beneficial action of strychnine in cer- 
tain cases may be due to its slight action on motor nerves, but other- 
wise these drugs are not employed for this action. 

C. Drugs acting on the Peripheral Endings of Sensory- 
Nerves (other than those of special sense). — As it is very diffi- 
cult to secure any satisfactory data regarding sensation from 
animals, our knowledge of the action of this group is neces- 
sarily derived almost entirely from observations on man. 

Drugs which Stimulate the Termination of Sensory Nerves. 
— These are the same as those already enumerated (p. 325) 
as acting locally on vessels. When topically applied they give 
rise to pain, and in the case of most of them the cause of the 
pain is the local inflammation they set up. 

Therapeutics. — It is for their action on the blood-vessels that 
local irritants are principally used, but they are not infrequently 
employed also for their counter-irritant effects. By their ap- 
plication to the skin it is probable that changes are induced in 



734 PHARMACOLOGY AND THERAPEUTICS. 

the calibre of the vessels and in the sensory nerves of internal 
organs, so that deep-seated pain is thereby relieved. The heart 
and respiration are also reflexly stimulated by peripheral exci- 
tation of nerves, and hence counter-irritation is made use of to 
rouse persons who have fainted or became unconscious from 
opium poisoning, etc. It is essential that the action should be 
a prompt one, and the application of the faradic current is quite 
commonly employed as an external stimulus in such cases. 

Drugs which Depress the Terminations of Sensory Nerves. — 
Of these there are two kinds: those which simply relieve pain, 
or local anodynes; and those which diminish sensibility, or 
local anaesthetics. 

Local Anodynes. — These have no action unless pain be present. They 



(i) Aconite. 

(2) Phenol. 

(3) Menthol. 

(4) Diluted hydrocyanic acid. 

(5) Veratrine. 

(6) Ether. ^v These must 

(7) Alcohol. I be allowed to 

(8) Chloroform. ] evaporate. 



(9) Hydrated chloral. 

(10) Belladonna. 

(11) Stramonium. 

(12) Hyoscyamus. 

(13) Scopola. 

(14) Opium. 

(15) Sodium bicarbonate. 

(16) Zinc oxide. 



In the above list the most powerful are placed first. The local 
anodyne action of opium has been disputed, and it is probable that 
many substances not included in this list which have been regarded as 
local anodynes have little if any claim to this designation. Cold is an 
effective local anodyne because of its depressant effect on sensibility, 
and so likewise is warmth, which relieves pain by diminishing tension, 
in consequence of the vaso-dilation which it primarily induces. 

Therapeutics. — Local anodynes, it may readily be supposed, 
are called for in a great variety of conditions, and while often 
of service as adjuvants to internal treatment, they are espe- 
cially useful in those affections in which it is not possible to 
remove the cause of the pain or irritation present. 

Local Anaesthetics. — These are cocaine, eucaine, holocaine, ortho- 
form, phenol, and extreme cold, whether produced by ice or by 



DRUGS ACTING ON NERVES AND MUSCLES. 735 

the evaporation of ethyl chloride, methyl chloride, or ether. As re- 
gards the performance of operations, the ether spray has the disad- 
vantage of stiffening the parts so that it is only useful for a single incision 
as for opening furuncles. Upon a damp day it is ineffectual. Ethyl chlo- 
ride sprayed from tubes by the heat of the hand is the best method and 
the one most frequently employed at present. Eucaine and cocaine, 
which produce a high degree of local insensibility, are largely employed. 

D. Drugs Acting on the Trunks of Nerves. — These, if taken 
for a considerable period, give rise to chronic neuritis, with 
much augmentation of the areolar tissue and also fatty degen- 
eration of the nerve-fibres. During the earlier stages of the 
inflammation much pain and tingling are experienced, but later 
these are replaced by numbness and diminished sensation as 
the function of the nerves becomes more and more depressed, 
and finally paralysis, often accompanied by trophic lesions, re- 
sults. These actions are of pathological, rather than pharma- 
cological, interest, and will be found fully described in works 
on medicine. 

The drugs producing peripheral neuritis are — 



(1) Lead. 

(2) Mercury. 



(3) Arsenic. 

(4) Alcohol. 



E. Drugs Acting on the Spinal Cord. — After the administra- 
tion of certain drugs it is found that a slight peripheral stimu- 
lus will produce such marked reflex action that convulsions will 
result. When this is due to stimulation of the spinal cord, it 
is determined in the following way: If the cord is cut across 
and convulsions are still caused by such slight stimulus, it is 
evident that these cannot be of cerebral origin, since in that 
case they would not take place below the point of section. On 
the other hand, if the drug does not cause convulsions when 
previously to its injection into the circulation the vessels of the 
cord have been ligatured, it is inferred that its action is not 
on the muscles or nerves. Other experiments going to show 
that the action is on the cord are the following: If when the 
drug is injected into vessels by which it reaches the cord 



73^ 



PHARMACOLOGY AND THERAPEUTICS. 



quickly, convulsions appear sooner than when it is injected into 
other vessels; if convulsions do not occur when the cord is 
destroyed ; if when the destruction of the cord is gradually pro- 
duced by pushing a wire down the vertebral canal, the convul- 
sions cease from above downward as the destruction proceeds. 

(i) The drugs increasing the irritability of the anterior cornua are — 



(i) Strychnine. 

(2) Brucine. 

(3) Ammonia. 

(4) Thebaine. 



(5) Chloroform. 

(6) Ether. 

(7) Ergot. 

(8) Opium. 



(The last four only slightly, and early in their action.) 

Therapeutics. — Strychnine is at times useful for paralysis 
resulting from diseases of the spinal cord, but with this excep- 
tion it is rare that affections of the cord are benefited by stimu- 
lation of the anterior cornua. 

(2) Drugs which depress the activity of the anterior cornua: 



(1) Physostigmine. 


(15) Lithium salts. 


(2) Gelsemium. 


(16) Antimony salts. 


(3) Muscarine. 


(17) Arsenical salts. 


(4) Bromides. 


(18) Camphor. 


(5) Alcohol. 


(19) Amyl nitrite. 


(6) Chloroform. 


(20) Sodium nitrite. 


(7) Ether. 


(21) Hydrated chloral 


(8) Ergot. 


(22) Phenol. 


(9) Opium. 


(23) Apomorphine. 


(10) Mercury. 


(24) Veratrine. 


(11) Zinc salts. 


(25) Turpentine. 


(12) Silver salts. 


(26) Saponin. 


(13) Sodium salts. 


(27) Emetine. 


(14) Potassium salts. 


(28) Colchicum. 



Of these, apomorphine, alcohol, chloroform, ether, arsenic, camphor, 
morphine, phenol, hydrated chloral, nicotine, and veratrine first excite 
slightly before depressing. 



DRUGS ACTING OX NERVES AND MUSCLES. 737 

Therapeutics. — So far as their action on the spinal cord is 
concerned, these drugs are of very little practical utility. Phys- 
ostigmine, which is by far the most powerful, has been tried to 
a considerable extent in tetanus and other diseases accompanied 
by convulsions, but with little benefit. 

F. Drugs Acting on the Brain. — The action of these can by 
no means be so distinctly localized as that of drugs acting on 
the spinal cord and nerves. Drugs acting on the brain illus- 
trate two very important general laws : 

(1) The law of dissolution, which, when stated as it applies 
in pharmacology, is as follows : When a drug affects functions 
progressively, those first affected are the highest in develop- 
ment ; that is to say, they are the last acquired by the individual 
and the last to appear in the species. The next affected are 
those next to highest, and so on; till finally the lowest of all 
from an evolutionary point of view, that is to say, the functions 
of respiration and circulation, are affected. This law is well 
exemplified in the case of alcohol, under the influence of which 
the first functions to be disordered are those of the intellect, 
especially the highest, such as judgment and reason; then follow 
disorders of movement, and finally death from failure of respi- 
ration and circulation. 

(2) When a drug in moderate doses excites a function, in 
large doses it often paralyzes it. Cerebral stimulants may thus 
also be hypnotics. 

Drugs Acting on the Motor Centres of the Brain. — To inves- 
tigate these, the motor area of the cortex is exposed by trephin- 
ing. One method is to note, before and after the administration 
of the drug, the strength of the electric current which it is neces- 
sary to apply to this area to produce corresponding movements. 
Another is to observe the strength of current necessary to elicit 
a movement and then to allow the wound made by the trephine 
to close; after which the drug is regularly administered to the 
animal for several weeks. The opposite motor area is then ex- 
posed, and the strength of the current required for the same 
purpose is noted. 
48 



738 



PHARMACOLOGY AND THERAPEUTICS. 



It has been found that the following diminish the activity of the 
motor area. 



(i) Alcohol. 

(2) Anaesthetics. 

(3) Hydrated chloral. 



(4) Potassium bromide. 

(5) Sodium bromide. 

(6) Ammonium bromide. 



It is on account of this action that bromides are largely em- 
ployed in epilepsy and other convulsive affections. 

Drugs exciting the motor cells of the cortex are — 



(1) Atropine. 

(2) Absinthium. 



(3) Strychnine. 

(4) Physostigmine. 



They are not used in medicine for this purpose. 

(1) General Cerebral Stimulants. — Experiments on animals 
are of no value in determining the effects of these. In the 
human subject they produce general excitation of the mental 
faculties, and this is not infrequently followed by confusion, 
incoherence and delirium, the character of the latter varying to 
some extent with the particular drug employed. In many in- 
stances the stimulation is soon replaced by a paralyzing in- 
fluence. 



Such drugs are — 




(1) Belladonna. 


(11) Guarana. 


(2) Stramonium. 


(12) Coca. 


(3) Hyoscyamus. 


(13) Cannabis Indica 


(4) Scopola. 


(14) Lupulin. 


(5) Alcohol. 


(15) Opium. 


(6) Chloroform. 


(16) Camphor. 


(7) Ether. 


(17) Santonin. 


(8) Nitrous oxide. 


(18) Quinine. 


(9) Coffee. 


(19) Salicylic acid. 


(10) Tea. 


(20) Tobacco. 



Therapeutics. — These are of the greatest importance in their 
therapeutic applications, and many of the drugs are taken habit- 
ually as cerebral stimulants in various parts of the world. 



DRUGS ACTING OX NERVES AXD MUSCLES. 739 

(2) General Cerebral Depressants. — These are commonly 
divided into three classes : Hypnotics or Soporifics. Narcotics 
and Anaesthetics. 

Hypnotics or Soporifics are drugs which produce sleep, 
closely resembling, if not identical with, natural sleep. It is 
known that during sleep the brain is anaemic, and it is probable 
that the anaemia is the cause of sleep. It may be that the action 
of some hypnotics is due to their inducing cerebral anaemia. 

The hypnotics are — 

(1) Opium. (10) Paraldehyde. 

(2) Morphine. (n) Alcohol. 

(3) Hydrated chloral. (12) Hyoscine. 

(4) Chloralamide. (13) Scopolamine. 

(5) Butyl-chloral hydrate. (14) Cannabis Indica. 

(6) Bromides. (15) Urethane. 

(7) Trional. (16) Lupulin. 

(8) Peilotine. (17) Lactucarium. 

(9) Sulphonal. 



Therapeutics. — In all cases of insomnia the underlying condi- 
tion should be carefully looked into and removed if possible. 
These drugs should be resorted to with the greatest reluctance 
on account of the danger of habituation. Chloral, if used with 
great caution, peilotine, paraldehyde, trional. and choralamine 
are perhaps the most satisfactory, but the use of hypnotics 
is apt to be greatly abused. It is well to remember that sleep 
may often be induced by causing dilatation of the vessels of 
other parts of the body than the brain. Thus,, a warm bath or 
a full meal tends to promote sleep. 

Narcotics are substances which not only produce sleep, but 
also in large doses depress the functions of respiration and cir- 
culation. Many of them fall also under the head of general 
anaesthetics; others are. in smaller doses, hypnotics. All must 
be given in considerable doses. 



740 PHARMACOLOGY AND THERAPEUTICS. 

The following is a list of them. 

(i) General Anaesthetics. i (6) Hyoscyamus. 

(2) Opium. (7) Scopola. 

(3) Hydrated chloral. (8) Alcohol. 

(4) Belladonna. (9) Cannabis Indica. 

(5) Stramonium. (10) Lupulin. 

Therapeutics. — They are of great value in .diminishing mor- 
bidly acute perception, relieving pain, allaying irritation, ner- 
vous excitability, and spasm, inducing sfeep, and regulating the 
vital functions by rest. For instance, opium and belladonna are 
sometimes of much service in cardiac disease. 

General Anesthetics. — These are drugs which lead to a 
total loss of consciousness, so that pain is no longer felt, while 
at the same time reflex action is abolished. They illustrate 
admirably the law of dissolution, and also the fact that, after 
excitement, paralysis often succeeds. The various stages of 
their action will be described under Chloroform and Ether. 

There are individual differences in the different anaesthetics, 
and different individuals are sometimes differently affected by 
the same anaesthetic. 



(3) The general anaesthetics are- 

(1) Chloroform. 

(2) Ether. 

(3) Nitrous oxide.' 

(4) Pental. 



(5) Ethyl bromide. 

(6) Many other substitution 

products derived from 
alcohols and ethers. 



Therapeutics. — Anaesthetics are given to cause unconscious- 
ness, so that pain may not be experienced during operations, to 
relax muscles in cases of dislocations, abdominal examinations, 
phantom tumors, etc., to relieve severe pain, such as that of 
parturition, biliary and renal colic, and to control convulsions, 
as in tetanus and hydrophobia. 

The chief dangers of anesthetics are — 1. Death from shock. 
This usually takes place before the patient is fully under the 
influence of the anaesthetic; reflex action being not yet quite 



DRUGS ACTING ON NERVES AND MUSCLES. 74 1 

abolished, the heart is stopped reflexly in consequence of the 
peripheral stimulus of the operation. Such a deplorable result 
may generally be avoided by taking care that the patient is fully 
under the influence of the anaesthetic before the operation is 
begun. 

2. Death from paralysis of respiration. This may be due to 
various circumstances. Thus, too much of the anaesthetic may 
have been given, the patient may be suffering from some disease 
of the lungs which renders respiration difficult, or the operation 
may demand a posture which interferes with the breathing. It 
is not usually a very grave danger, as warning is afforded by the 
lividity of the surface. Changing the posture and the with- 
drawal of the anaesthetic are often all that is required to restore 
the patient, but artificial respiration, with the head thrown back 
and the tongue pulled forward, may be called for, and in some 
instances it is necessary to maintain this for hours. 

3. Cardiac failure may occur if the vapor is too concentrated. 
Gradual heart-failure is always preceded by respiratory changes, 
but cardiac arrest may occur suddenly and without warning. 
The patient all at once grows pale, and the pulse stops. In such 
a case the anaesthetic should be discontinued, the patient should 
be placed in the inverted posture, and artificial respiration main- 
tained as before. The heart may be stimulated by large rectal 
injections of hot normal saline solution or of coffee, if at hand, 
by the inhalation of amyl nitrite, by the plunging of electric 
needles into the heart or, better, by making a series of forcible 
compressions of the chest over the heart; also, if the reflexes 
are not abolished, by flicking the chest over the heart with hot 
towels and placing hot compresses over it. Giving brandy sub- 
cutaneously is to but add the effect of one poison to that of an- 
other. The application of the faradic current over the cardiac 
region is also objectionable. 

4. Vomited matter or, if the operation is about the mouth, 
blood, may suffocate the patient. No food should be taken for 
some time before the operation, and if the patient is sick at the 



74 2 PHARMACOLOGY AND THERAPEUTICS. 

stomach, he should be turned on his side. In operations about 
the mouth special precautions are required. 

G. Drugs Acting on the Eye. 

i. Drugs Acting on the Pupil. — If when a drug having the 
property of dilating or contracting the pupil is applied locally 
to one eye, it acts promptly and powerfully, and only upon the 
eye into which it is dropped, it is evident that its action must 
be local. So also when it acts on an excised eye. Again, if 
the drug will act when thrown into the eye after all the vessels 
going to the eye are ligatured, but will not act when thrown into 
the general circulation, its action is shown to be local. On the 
other hand, if after being dropped into one eye it acts but feebly 
and after some time upon both eyes, it is to be inferred that its 
action is a central one. So, if all the vessels of the eye are 
ligatured, and the drug will not act if dropped in the eye, al- 
though it would do so if thrown into the general circulation, it 
is proved to act centrally. If such a drug acts when locally 
applied, the inference is that its action is due to the fact that 
some of it has been absorbed. 

As to the manner in which a centrally-acting drug exerts its 
influence, it has been shown that it may act either upon the 
muscular fibres of the iris, upon the terminations of the third, 
or motor oculi, nerve in these fibres, or upon the terminations 
of the cervical sympathetic in them. Stimulation of the third 
nerve causes the pupil to contract and stimulation of the cer- 
vical sympathetic causes it to dilate; while section of these 
nerves produces just the opposite effects. If, when the pupil is 
dilated by the local action of a drug, stimulation of the third 
nerve will not cause contraction, notwithstanding the muscular 
fibres are responsive to mechanical stimulation, it shows that the 
terminations of the third nerve are paralyzed. If, on the other 
hand, the pupil is contracted by the drug, and although respon- 
sive to mechanical stimulation, will not dilate after section of 
the third nerve, it shows that the terminations of this nerve 
are stimulated. If a drug, locally applied, causes dilatation of 
the pupil, but not to the same extent as is caused by stimulation 



DRUGS ACTING ON NERVES AND MUSCLES. 743 

of the sympathetic, it is shown that its whole effect is not due 
to stimulation of the sympathetic; and if the muscle remains 
locally irritable, there must be paralysis of the terminations of 
the third nerve. In a similar way the actions on the sympa- 
thetic may be determined. It has been found, however, that 
many drugs act both on the third nerve and on the sympathetic, 
and in the following list they are classified under their main 
actions : 
Mydriatics (dilate the pupil) — 

A. Paralyze the termination of the third nerve. 

(6) Gelsemine. 



(1) Atropine. 

(2) Homatropine. 

(3) Daturine. 

(4) Hyoscyamine. 

(5) Coniine. 



(7) Muscarine. 

(8) Hydrocyanic Acid. 

(9) Aconite. 

(10) Amyl nitrate. 



prob- 
ably. 



B. Stimulate the terminations of the sympathetic. — Cocaine. 

C. Act centrally. — Anaesthetics (late in their action). 

Myotics (contract the pupil). 

A. Stimulate the terminations of the third nerve. — Pilocarpine, and 
nicotine (probably). 

B. Stimulate the muscle. — Physostigmine. 

C. Act centrally. — Anaesthetics (early in their action) and Opium. 

Therapeutics. — Dilators of the pupils, especially atropine and 
homatropine, are used to dilate the pupil for ophthalmoscopic 
examination, and to prevent or break down adhesions of the 
iris. Contractors of the pupil, especially physostigmine, are 
used to overcome the effects of atropine, to prevent or break 
down adhesions of the iris, and to prevent too much light enter- 
ing the eye in painful diseases of the organ. 

2. Drugs Acting on the Ciliary Muscle. — The following 
drugs impair or paralyze accommodation: 



(1) Atropine. 

(2) Daturine. 

(3) Hyoscyamine. 

(4) Homatropine. 

(5) Cocaine. 



(6) Physostigmine. 

(7) Pilocarpine. 

(8) Gelsemine. 

(9) Coniine. 



744 PHARMACOLOGY AND THERAPEUTICS. 

Intra-ocular tension is increased by atropine (large doses), 
hyoscyamine, and daturine. It is decreased by cocaine, hyos- 
cine, and physostigmine. 

Gelsemine paralyzes the external ocular muscles, especially 
the levator palpebral and the external rectus, by its action on 
the terminal nerve filaments. 

Cocaine, by stimulating the unstriped fibres in the orbital 
membrane and the eyelids, causes the eye to protrude. Coniine, 
when given in large doses, produces ptosis. 

The capacity for seeing blue is increased by strychnine. San- 
tonin causes first violet, then yellow vision. 

H. Drugs Acting on the Ear. — Very little is known of the 
action of drugs upon the organ of hearing. Some substances, 
such as quinine and salicylic acid, cause ringing and buzzing in 
the ears, and sometimes deafness. 

I. Drugs Acting on the Sympathetic System. — The principal 
points in regard to the actions of drugs on the sympathetic sys- 
tem have already been touched upon in discussing their actions 
upon blood-vessels. In regard to nicotine, it is a curious cir- 
cumstance that if a large dose of it is administered, or if the 
substance be locally applied to the superior cervical ganglion, 
stimulation of the nerve below the ganglion fails to produce its 
characteristic effects, although these still result from stimulation 
of the nerve above the ganglion. 

B. Drugs Acting on the Peripheral Endings of Motor 
Nerves. 

CURARE. 

Unofficial Preparation. 

Curara. — Curare, (Wourara. Ourari. Urari. Wourali.) 

gr. 

Action of Curare. 
The characteristic effects of curare are paralysis of the nerve 
endings in striped muscles and, later, paralysis of the nerve end- 



conium. 745 

ings around sympathetic ganglia. Under very large doses there 
is induced a direct depression of the irritability of the muscle 
substance. In some instances tetanic convulsions, from an 
action on the central nervous system, are caused before the 
characteristic curare action makes its appearance, but under 
ordinary conditions, and especially if the amount given is only 
moderately large, these are masked by the paralysis of the 
nerve endings. When curare is applied directly to the spinal 
cord, it gives rise to typical strychnine convulsions. It is elim- 
inated chiefly in the urine, but some of it appears also in the 
faeces. The urine of a curarized animal will poison another 
one, and this may be repeated to several animals. 

Therapeutics of Curare. 
It has been used, by hypodermatic injection, with a limited 
measure of success in tetanus. It has also been tried in hydro- 
phobia, and recoveries have been reported from its employment 
in two alleged cases of this disease. In epilepsy some observers 
have found it beneficial, and it has been experimented with in 
the treatment of various other nervous affections. In practice 
it has proved unsuccessful as an antidote in strychnine poi- 
soning. 

CONIUM. 

CONIUM.— Conium. (Spotted Hemlock.) Dose, 0.200 gm. (200 
milligm.) ; 3 gr. 

Preparation. 
Fluidextractum Conii. — Fluidextract of Conium. Dose, 0.2 
c.c; 3 n\. 

Unofficial Preparations. 
Extractum Conii (U. S. P., 1890). — Extract of Conium. 
Dose, 0.02 to 0.05 gm.; y 3 to 1 gr. 

Succus Conii. — Juice of Conium (B. P.). Dose, 4 to 8 c.c; 
1 to 2 fl. dr. 

Coniina.— Coniine. Dose, 0.003 to 0.01 c.c; fa to 1 n\,. 



746 PHARMACOLOGY AND THERAPEUTICS. 

Action of Conium. 

External. — It has no action on the unbroken skin. When 
applied to bruised surfaces it has been alleged to exert some- 
thing of an anaesthetic influence, but, in view of the manner of 
action of the drug, very large doses being required to produce 
a depressant effect upon the sensory nerves, this seems im- 
probable. 

Internal. G astro-intestinal Tract. — Coniine, even when in- 
jected directly into the circulation, causes nausea and frequently 
vomiting at an early stage of its action, and this effect is no 
doubt due to a medullary influence. The nausea is accom- 
panied by profuse salivation and sometimes by perspiration. 
Large doses by the mouth may produce some diarrhoea, as well 
as vomiting. 

Circulation. — The cardiac action is not marked. As the in- 
hibitory mechanism is stimulated, the pulse is usually rather 
slow and weak. Sometimes, however, paralysis of the ganglia 
on the inhibitory nerve may cause its acceleration. A consid- 
erable, though transient, increase in the arterial tension which 
is observed has been attributed to a stimulation of the gangli- 
onic apparatus situated in the course of the vaso-constrictor 
nerves. 

Respiration. — The respiration is at first quickened and deep- 
ened, but later becomes slow and labored, and then weak and 
irregular. It finally ceases while the heart is still strong, and 
the asphyxia is believed by the majority of recent investigators 
to be due to paralysis of the nerve endings in the diaphragm. 
Many, however, consider that the respiratory centre in the 
medulla is paralyzed before these terminations. 

Nervous System. — In the frog the chief effect is a paralysis 
of the motor nerve terminations, such as is caused by curare, 
but it is thought probable that while in frogs the symptoms are 
all due to the action on the nerve endings, in mammals, in 
whom this paralysis is much less marked, some of the phenom- 
ena observed are due to central stimulation and to subsequent 
paralysis of the respiratory centre. On the nerve terminations 



conium. 747 

in ganglia coniine acts in the same way as curare. It is found 
that after large doses of the drug, the inhibitory impulses, owing 
to paralysis of the ganglionic apparatus, no longer reach the 
heart, and that stimulation of the vagus nerve has no effect on 
the pulse-rate. Weak convulsive movements are often observed 
before death, but they are due simply to the asphyxia. 

In the earlier stages of the intoxication, twitchings and tre- 
mors may occur. While coniine has been supposed to have a 
narcotic depressing action on the central nervous system, this 
is by no means a characteristic feature of its effects. Languor 
and drowsiness are observed, but the latter does not pass into 
actual sleep. In both man and animals consciousness is gen- 
erally retained until immediately before the cessation of respira- 
tion, and in most cases the intelligence remains clear to the end, 
as in the case of Socrates. 

In man the main symptoms relate to the motor, system, and 
these are very characteristic. Under poisonous doses there is 
an ascending paralysis, beginning with the lower extremities 
and finally reaching the tongue, so that the patient may be un- 
able to speak, though his intellect remains unimpaired. This 
ascending paralysis has been ascribed to a lowered conductivity 
of the spinal cord to impulses coming from the brain, the path 
being blocked at first only to those impulses which have a long 
distance to traverse. The sensory, as well as the motor, nerves 
are depressed. 

Eye. — In coniine poisoning the pupils are generally somewhat 
dilated, and ptosis also occurs, indicating that the dilatation is 
due to oculo-motor paralysis. In many instances imperfect 
vision, from paralysis of accommodation, is noted. 

Excretion. — Coniine is excreted in the urine, and very rap- 
idly, so that its action passes off quite soon even when a con- 
siderable quantity has been taken. 

Therapeutics of Conium. 
External. — Hemlock leaves, in the form of poultices and oint- 
ments, have been applied to painful swellings and ulcers, but 



74-8 PHARMACOLOGY AND THERAPEUTICS. 

are of doubtful benefit. Conium applications for the relief of 
myalgia or rheumatic pains are quite useless. 

Internal. — Conium has fallen into almost complete disuse, and 
one reason for this is the unreliability of its preparations, which 
may contain no coniine whatever. This substance is very vola- 
tile and unstable, and light and air render it inert. Succus 
Conii (B. P., the expressed juice of the leaves and young 
branches, to which 25 per cent, of alcohol is added) is generally 
considered the most reliable preparation of the drug, but it is 
stated that ounces of it have been taken without producing any 
effects. Conium has been employed in spasmodic affections, as 
chorea, paralysis agitans, tetanus, epilepsy, whooping-cough, 
asthmatic attacks and laryngismus stridulus, and also in mani- 
acal and hysterical excitement. It has little value except in 
spasms due to irritation of a nerve-trunk, when it may perhaps 
be of service. In those of cortical or spinal origin other reme- 
dies should certainly be employed, as the physiological action of 
the drug shows that it has really very little quieting effect upon 
the central nervous system, but only prevents the impulses which 
are sent out from manifesting themselves in movements of the 
muscles. 

TOXICOLOGY. 

Attention has already been called to the languor and drowsiness and 
to the eye-symptoms in cases of poisoning. The other phenomena have 
been so accurately described by Plato in his account of the death of 
Socrates, who was probably given the expressed juice of the root, that 
his words may be taken as a fair representation of the ordinary symp- 
toms : " He went about, and as he noticed that his thighs became heavy, 
he lay down on his back, as the man directed. The latter — the one who 
had given him the poison — touched him from time to time, and examined 
his feet and thighs. Then he pressed his foot strongly, and asked 
whether he could feel it ; he answered, No. Then he tried the knees, 
and so went higher and higher, and showed us how he gradually became 
cold and stiff. Then he touched him once more, and said that when it 
came to the heart he would be dead. Now almost everything from 
the abdomen down was cold." The mental powers of the sage re- 
mained unimpaired until near the end. Post-mortem. — No distinctive 
lesions are found, but only the usual indications of death from asphyxia, 
such as engorgement of the organs with venous blood. 



tobacco. 749 

Treatment. — Emetics (see p. 175) should be administered and the 
stomach washed out. Then tannic acid should be given freely, and 
the stomach again washed out. Strychnine, as a respiratory stimulant, 
and other stimulants, by hypodermatic injection, are called for. Warmth 
should be applied to the surface and artificial respiration resorted to. 

TOBACCO. 

Unofficial Preparations. 
Tabacum (U. S. P., 1890).— Tobacco. 
Nicotinae Salicylas. — Nicotine Salicylate. (Eudermol.) 
Pyridina. — Pyridine. Dose, .40 to 1.50 c.c; 6 to 25 TTL daily. 

Action of Tobacco. 

External. — Nicotine is powerfully antiseptic. It is absorbed 
from the unbroken skin, as well as from abraded surfaces and 
mucous membranes. 

Internal. — The action of tobacco is due to nicotine, which is. 
one of the most fatal and rapid poisons known. Very large 
doses may cause death within a few seconds. 

Gastro-intestinal Tract. — Even in very small doses (.009 gm. ; 
-i gr.) nicotine, by its stimulation of the ganglia, causes in- 
creased salivary secretion. It produces irritation of the fauces 
and a burning sensation in the mouth, oesophagus and stomach, 
with extreme nausea. The sensation of heat spreads from the 
epigastric region all over the body. Nicotine is a violent 
gastro-intestinal irritant, and vomiting and purging quickly set 
in. The drug causes contraction of the muscular coats of the 
hollow viscera, and this is chiefly a peripheral effect, but is also 
due in part to stimulation of ganglia within the walls. Thus, 
the stomach is thrown into contraction, and powerful and spas- 
modic movement of the intestine occurs, with repeated evacua- 
tion of its contents. A special feature of the action is the 
profound collapse which attends these effects. 

Circulation. — The heart appears to be at first slowed in con- 
sequence of stimulation both of the vagus centre and the vagus 
ganglia. Very soon, however, its action becomes markedly ac- 



750 PHARMACOLOGY AND THERAPEUTICS. 

celerated and irregular, from paralysis of the ganglia, which 
obstructs the passage of the inhibitory impulses from above. If 
the dose of the alkaloid is sufficiently large, however, no slow- 
ing is caused, as immediate paralysis of the ganglia then results, 
without any primary stimulation. In addition, nicotine has 
some direct action on the cardiac muscle, which apparently is 
first stimulated and then depressed. A rise in blood-pressure is 
produced partly by the quickened action of the heart and partly 
by vaso-constriction from stimulation of the constrictor ganglia. 
This stimulation also is succeeded by depression, and in con- 
sequence of this, as well as the enfeebling action on the heart, 
the blood-pressure falls. Owing to the increased irritability of 
the cardiac muscle caused by the drug, the heart may continue 
to beat for a considerable time after death. Nicotine produces 
disintegration of the red corpuscles in freshly-drawn blood, but 
is not found to have this effect upon living blood, although the 
spectrum of haemoglobin is said to be altered by it. 

Respiration. — The respiratory centre in the medulla is first 
stimulated, then depressed, and finally paralyzed. As a result 
of the stimulation, the respiratory movements are accelerated 
and deepened; later they become slow, shallow and irregular, 
and death occurs from asphyxia. During the convulsions 
caused by the alkaloid they are completely arrested. Before 
the effects of central stimulation of the respiration become evi- 
dent, however, it has been observed that the breathing is tem- 
porarily shallow and at the same time rapid, with some defi- 
ciency of the expiratory movements, and this is believed to be 
due to an irritation of the pulmonary branches of the pneumo- 
gastric. 

Nervous System. — When very large doses prove almost in- 
stantaneously fatal, the symptoms are those of sudden paralysis 
of the central nervous system, including the respiratory centre. 
In these exceptional instances no convulsions are observed. 
The regular action of the drug is a stimulation, followed by 
depression, of the whole cerebro-spinal axis, from above down- 
ward. The effect of considerable amounts on the cerebrum is 



TOBACCO. 751 

to cause evanescent excitement, with violent headache, which 
is quickly succeeded by a comatose condition. In the medulla 
oblongata nicotine affects particularly the respiratory, vagus, 
vaso-constrictor and convulsive centres, while the salivation and 
vomiting caused by it are probably also partly of medullary 
origin. Its action on the spinal cord is shown by increased 
excitability, tremors and heightening of the reflexes. Convul- 
sions also are observed, but as these are clonic instead of tonic 
in type, and are found to be much weaker after division of the 
cord immediately below the medulla than in the intact animal, 
it is concluded that they have their seat in the medulla and hind 
brain rather than in the cord. The peripheral actions are essen- 
tially the same as those of pilocarpine, with the exception that 
the stimulation is shorter and under large doses entirely absent, 
while the depression is much more marked. Nicotine causes a 
stimulation, and subsequently more lasting paralysis, of sympa- 
thetic ganglia in all situations. In the skeletal muscles there 
are produced fibrillary twitchings, which are succeeded by 
complete paralysis of the nerve endings, as in the case of curare. 
Ultimately, therefore, the function of the motor nerves is abol- 
ished, and as a result of this there is intense muscular weakness. 

Unstriped Muscle. — As has been mentioned, the stomach is 
powerfully contracted. This contraction extends throughout 
the intestine, and eventually results in a tetanic condition 
which for a time arrests peristalsis, though afterwards the wave 
contractions recur with increased vigor. Similar contraction 
occurs in the uterus and bladder. In consequence of the latter 
being thrown into this tetanic contraction, the urine is expelled 
very soon after the injection of nicotine, and on this account, 
no doubt, the impression has obtained that the drug augments 
the renal secretion. Apparently, however, it has no diuretic 
action. 

Eye. — The influence of nicotine on the pupil differs in differ- 
ent animals, and it is supposed that the varying effects are prob- 
ably due to the amount of stimulation relatively exerted upon 
the ciliary and the superior cervical ganglia in different in- 



752 PHARMACOLOGY AND THERAPEUTICS. 

stances. In acute poisoning in man the pupil is generally first 
contracted and then dilated. 

Secretion. — Reference has already been made to the increased 
secretion of saliva. The seat of action is the ganglionic appa- 
ratus of the secretory nerves, and there is at first stimulation 
and later, depression; so that the secretion is eventually much 
lessened or suppressed from paralysis of the apparatus. If the 
dose is sufficiently large, the saliva is diminished at once. The 
other secretory glands appear to be affected in the same way ; 
the secretions of the sweat, lachrymal and bronchial mucous 
glands being increased and afterwards diminished. The secre- 
tion of bile and urine does not seem to be so dependent upon 
nervous influences, and it has not been shown that these secre- 
tions are affected by nicotine. 

Excretion. — Nicotine is eliminated by the kidneys, and, to a 
less extent, probably by the lungs. It has also been detected 
in the sweat and saliva. It is believed that that which is ab- 
sorbed from the stomach and intestine usually loses much of its 
toxic activity during its passage through the liver. 

Therapeutics of Tobacco. 

An excellent poultice for epididymitis is made of fine-cut 
tobacco and flax-seed. In non-smokers tobacco is useful to 
relieve the symptom asthma, and for this purpose it is often 
mixed with stramonium, belladonna, etc., and the smoke inhaled. 
Pulverized tobacco, or snuff, has been employed for arresting 
stubborn paroxysms of hiccough, a pinch being drawn into the 
nostrils by a strong inspiration. Enemata made from the leaves 
were formerly used sometimes for purgative purposes and also 
to relax muscular spasm and so facilitate the reduction of dis- 
locations, herniae, etc. The objects for which tobacco was at 
one time employed, however, can now be accomplished more 
efficiently and safely by anaesthetics and other agents. 

Nicotine salicylate (eudermol), in the form of an ointment 
(i per cent), is said to be efficacious in the treatment of scabies 
and to possess the adavntage of not staining the linen, as well 



tobacco. 753 

as being odorless. Pyridine which is found in tobacco, but com- 
mercially is obtained from other sources, when administered by 
inhalation will frequently relieve the paroxysms of asthma. 
For this purpose 4 c.c. (1 fl. dr.) is generally placed in a 
dish, so that it may slowly evaporate. Its persistent and abom- 
inable odor is a great obstacle to its use. 

Tobacco smoking is often indulged in on the supposed ground 
that it aids digestion and that after breakfast it promotes the 
daily movement of the bowels. It appears in many instances, 
particularly in persons who lead sedentary lives, to stimulate 
the mental powers and induce a feeling of serenity. Many indi- 
viduals use tobacco to a moderate extent for many years with 
impunity, but its excessive use not infrequently leads to more 
or less serious disorders. One of the most common effects is 
a catarrhal condition of the throat and upper parts of the respi- 
ratory passages. The tongue is also irritated, especially when 
the smoke is concentrated on one point, as in pipe-smoking, and 
it has been thought that this constant local irritation may favor 
the development of cancerous disease in the tongue or lip. 
Other effects liable to be produced are dyspepsia and want of 
appetite, with consequent loss of flesh, palpitation and irregu- 
larity of the heart, vertigo, depression, neuralgia, insomnia, 
muscular weakness, and various ocular disturbances. Atrophy 
of the optic nerve may eventually result, and chronic nicotine 
intoxication is said to favor arterio-sclerosis. The use of to- 
bacco in those who are unaccustomed to it almost invariably 
causes nausea and vomiting attended by depression, which may 
even amount to collapse. The records of the senior classes of 
Yale University for eight years showed that those who used no 
tobacco were 20 per cent, taller, 25 per cent, heavier, and had 
66 per cent, more lung capacity than the smokers. 

TOXICOLOGY. 
The symptoms are those which we would expect from the physiological 
action of nicotine. Thus, there are marked nausea, vomiting and purg- 
ing, accompanied or followed by profound collapse, with coldness and 
clamminess of the surface, icy extremities, a weak and rapid pulse, great 
49 



754 PHARMACOLOGY AND THERAPEUTICS. 

dyspnoea, and extreme muscular weakness. There is usually partial loss 
of consciousness, and convulsions are often observed. Notwithstanding 
the extreme toxicity of nicotine, in animals as well as man a certain 
tolerance may be acquired. Post-mortem. — When the poison is taken 
by the mouth there may be more or less hyperemia of the gastric and 
intestinal mucous membrane, since nicotine is sufficiently alkaline to be 
somewhat caustic ; but the appearances are not characteristic. The odor 
may furnish a valuable indication. 

Treatment. — Tannic acid followed by emetics (see p. 175). Strych- 
nine is the true physiological antidote. Alcohol and ammonia stimu- 
late the heart. The recumbent position must be maintained. Artificial 
respiration may be necessary. 

LOBELIA. 
LOBELIA.— Lobelia. (Indian Tobacco.) Dose, 0.5 gin.; 7V 2 gr. 

Preparations. 
1. Fluidextractum Lobeliae. — Fluidextract of Lobelia. Dose, 
0.5 c.c; 8 TH,. 

2. Tinctura Lobelia. — Tincture of Lobelia. Dose, (expecto- 
rant) 1 C.C.; 15 TTt; (emetic) 4 C.C.; 1 fl. dr. 

Unofficial Preparation. 
Infusum Lobelia. — Infusion of Lobelia. Dose, 15 to 30 c.c; 
y 2 to 1 fl. oz. 

Action of Lobelia. 

External. — Lobelia is absorbed through the skin, but has no 
local action on it. The local application of lobeline to the eye 
is followed by contraction of the pupil, though in general poi- 
soning by it dilatation has been observed. 

Internal. G astro -intestinal Tract. — Lobelia is a powerful 
gastro-intestinal irritant. Ordinarily, however, it produces 
violent vomiting without any action on the bowels, as most of 
it is expelled by the emesis, which is attended by extreme pros- 
tration. When the vomiting is insufficient to get rid of the 



LOBELIA. 755 

poison it causes active purging, and the collapse condition is 
marked. When injected into animals lobeline induces vomit- 
ing and salivation, these effects being ascribed to stimulation 
of the medullary centres. 

Circulation. — In consequence of its action on the inhibitory- 
apparatus of the heart, the pulse-rate is slowed at first, but after- 
wards is more or less accelerated. The blood-pressure, at first 
diminished, is afterwards increased beyond the normal. As a 
result of vomiting, however, marked variations in the rate of 
the heart and in the arterial tension are apt to be observed. In 
the collapse resulting from the gastro-intestinal irritation caused 
by lobelia the pulse is naturally small and weak. 

Respiration. — Small doses stimulate and large doses paralyze 
the respiratory centre, while the vagus terminations in the mus- 
cular coat of the bronchi or in ganglia in the lungs are also 
paralyzed by lobeline. The respiratory movements may at first 
be much increased in rate and force. Later they become dysp- 
nceic and asphyxia supervenes, death occurring from respira- 
tory failure. 

Nervous System. — When injected into mammals lobeline in- 
duces increased reflex irritability, as well as accelerated respira- 
tion. The same is true as regards frogs, so that it is inferred 
that in both it causes primary stimulation of the spinal cord 
and of the medulla oblongata. Only in the frog, however, does 
there appear to be any action on the higher divisions of the 
nervous system. They are depressed in frogs and in them the 
terminations of the motor nerves are paralyzed in the same 
manner as by curare. In man and warm-blooded animals gen- 
erally coma and convulsions may be observed after poisonous 
amounts, but they would seem to be simply a result of the as- 
phyxia. By some, however, these effects are regarded as due 
to a direct action on the higher cerebral centres. 

Excretion. — Lobelia is apparently excreted by the kidneys 
and to some extent by the skin, and it is credited with a diuretic 
and diaphoretic action. 



7 $6 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Lobelia. 

External. — As an external application tincture of lobelia, with 
an equal quantity of glycerin, is a most useful remedy for the 
relief of pain in acute epididymitis. An infusion (i to 16) may 
be used for the dermatitis of poison ivy. 

Internal. — As it has the effect of relaxing bronchial muscle, 
the chief use of lobelia is for the relief of the symptom asthma. 
4 c.c. (i fl. dr.) of the tincture may be given until nausea is 
induced, and as soon as this appears it should be discontinued. 
The administration of .6 c.c. (io HI) every ten minutes, if begun 
early, often shortens the paroxysm. Lobelia is also employed 
to some extent as an expectorant in bronchitis, and especially 
when the latter is characterized by a spasmodic element. It is 
often combined with other antispasmodics and expectorants. 
In both bronchitis and asthmatic attacks its good effects are no 
doubt largely due to the free secretion of mucus which is pro- 
duced by its nauseant action. It is, relatively, better borne by 
children than by adults. It was formerly prescribed as an 
emetic and also as a purgative, but it is now regarded by most 
as too depressing to be used for these purposes, while its action 
as a purgative is very uncertain. In very small doses, how- 
ever (.06 to .12 c.c; 1 to 2 Til every hour, or .6 c.c; 10 in. at 
bed-time), the tincture is still recommended by some writers 
as useful in promoting peristalsis and intestinal secretion in 
cases of habitual constipation, dependent upon atony of the 
muscular layer and deficient secretion of the bowel, where 
there is an impacted caecum, but no inflammatory action has 
supervened. An infusion of lobelia has sometimes succeeded 
in relieving strangulated hernia, intussusception and faecal im- 
paction, and is regarded as safer than tobacco. 

C. Drugs Acting on the Peripheral Endings of Sensory 

Nerves. 

MENTHOL. 

MENTHOL.— Menthol. Dose, 0.065 gm. (65 milligm.) ; 1 gr. 



MENTHOL. 757 

Action of Menthol. 
Menthol is antiseptic and locally anaesthetic, producing a 
sensation of coldness wherever it is applied. The blood-vessels 
of the part are, however, dilated, and instead of there being a 
fall of temperature, the skin temperature is higher there than 
elsewhere. The drug is generally regarded as exerting a pecu- 
liar stimulating effect upon the nerves conveying the sense of 
cold, but this has been denied by some authorities, who assert 
that it acts only on the terminations of the nerves of common 
sensation or pain. The feeling of coldness is associated with 
more or less prickling, and later there follows some heat and 
burning. Like camphor, menthol stimulates the central ner- 
vous system, and its general effects are practically identical, 
except that the convulsions to which it gives rise are much less 
severe. It is excreted in combination with glycuronic acid. 

Therapeutics of Menthol. 
Menthol, externally applied, will often relieve neuralgic pains, 
provided they are of superficial and peripheral origin. The 
solid menthol, in the form of a pencil or cone, is sometimes 
employed for this purpose, and sometimes it is used in alcoholic 
solution, or in a solution of oleic acid (i to 2.4) made by heat. 
A menthol plaster is composed of menthol, 3 ; yellow wax, 1 ; 
rosin, 15; and an excellent liniment, of menthol, 3; chloroform, 
4; olive oil, 9. Rubbed up with an equal part of camphor, 
chloral or pure phenol, and placed in the cavity, it promptly 
cures the aching of a carious tooth. It has considerable 
power in controlling superficial inflammations, and in an 
ethereal solution of from 10 to 50 per cent, may be applied two 
or three times a day for the purpose of aborting boils, car- 
buncles, cutaneous abscesses, etc. An excellent combination 
for inflamed joints, whether the inflammation is rheumatic or 
gonorrhceal, is a mixture of menthol, thymol and hydrated 
chloral (each 8 gm. ; 2 dr.), rubbed up together until liquefied, 
and to which are added morphine sulphate, .13 gm. (2 gr.) and 
atropine sulphate, .008 gm. (^ gr.), or cocaine hydrochloride, 



758 PHARMACOLOGY AND THERAPEUTICS. 

.06 gm. (1 gr.). Or, a solution of menthol, thymol and chloral 
in ether or chloroform may be painted over the inflamed part. 
These combinations are also applicable in local neuralgias. 
Menthol is very useful for allaying itching, and is employed in 
solutions (to which other drugs may be added, if called for), in 
such affections as pruritus ani, urticaria, eczema and herpes 
zoster. In laryngeal and tracheal tuberculosis great relief is 
afforded by a 20 per cent, solution in olive oil, introduced into 
the larynx with a syringe or spray, and followed by inhalations 
of the same from boiling water or by means of a respirator. 
A pigment of 1 to 4 of the oil may also be employed for paint- 
ing the larynx. In bronchiectasis the injection twice daily of 
4 c.c. (1 fl. dr.) of a mixture composed of menthol, 10; guaiacol, 
2; olive oil, 88, has been followed by marked improvement. 
Inhalations of menthol (volatilized in a tea-pot by the addition 
of hot water) have sometimes proved successful in relieving 
the symptom asthma. It has also been used by inhalation in 
hay fever and diphtheria. In solution, or rubbed up with sugar 
(5 to 10 per cent.), it may be applied by means of a large cam- 
el's hair brush as a disinfectant and anodyne for the throat in 
diphtheria, scarlet fever, tonsillitis, pharyngitis, etc. A 10 per 
cent, alcoholic solution, applied on cotton wool, is preferred by 
some. Menthol is now used to a considerable extent topically 
in diseases of the ear and nose. In the nasal form of hay fever 
a mixture of menthol and ammonium carbonate has been found 
to make a very efficient smelling-salt. Internally menthol has 
been used in small doses (.006 gm. ; -J^ gr.) to relieve nausea 
and vomiting. In doses of .10 gm. (i*/2 gr.), in capsules with 
olive oil (six or eight being taken daily), it has been given as 
an intestinal antiseptic. It is also said to have been used with 
advantage, by means of the stomach-tube, in cases of atonic 
dyspepsia. The stomach is first washed out and then a 1-5 per 
cent, solution of menthol in liquid petroleum is blown through 
the tube. In spasmodic cough, asthma and hiccough its inter- 
nal administration is sometimes of service. 



coca. 759 

COCA. 
COCA. — Coca. (Erythroxylon. Cuca.) Dose, 2 gm.; 30 gr. 

Preparations. 
Fluidextractum Cocae. — Fluidextract of Coca. Dose, 2 c.c; 
30 Til. 

Vinum Cocae. — Wine of Coca. Dose, 16 c.c; 4 fl. dr. 

Cocaina. — Cocaine. Dose, 0.030 gm. (30 milligm.) ; y 2 gr. 

Oleatum Cocainae. — Oleate of Cocaine. 

Cocainae Hydrochloridum. — Cocaine Hydrochloride. Dose, 
0.030 gm. (30 milligm.) ; y 2 S r - 

Unofficial Preparation. 
Trochiscus Krameriae et Cocainae (B. P.). — Krameria and 
Cocaine Lozenge. Dose, 1 lozenge. 

Action of Coca. 

External. — Cocaine has little or no action on the unbroken 
skin, but upon mucous membranes or the subcutaneous tissue 
it produces complete local anaesthesia. At first, owing to the 
contraction of the vessels caused, the surface to which it is 
applied becomes somewhat blanched, but later there is hyper- 
emia with increased redness of the part, in consequence of 
secondary vascular dilation. A 5 to 10 per cent, solution of 
the hydrochloride will paralyze the sensory nerves, but to pro- 
duce this effect on motor nerves requires a much stronger dose. 
The local application of cocaine to the tongue abolishes the 
sense of taste, and to the nose, that of smell. This alkaloid is a 
typical protoplasmic poison, and its effects as a local anaesthetic 
are no doubt attributable to its destructive action on the proto- 
plasm of the end organs. 

Internal. G astro -intestinal Tract. — In South America from 
time immemorial the natives have chewed coca leaves to relieve 
hunger and fatigue. On account of its anaesthetic effect on the 
gastric mucous membrane cocaine deadens the sensation of 
hunger, and tends to allay irritability of the stomach, but the 



760 PHARMACOLOGY AND THERAPEUTICS. 

drug is not an aliment, and if no food is taken, rapid emaciation 
occurs under its use. In exceptional instances vomiting is 
caused when poisonous quantities are swallowed. According 
to some observers intestinal peristalsis is markedly increased by 
moderate doses, while after large doses this increase is followed 
by great sluggishness, deepening into paralysis. 

Circulation. — The pulse-rate is lessened by very small doses, 
in consequence of stimulation of the vagus centre, but increased 
by large doses, which depress the vagus. Usually, but not, it 
is said, invariably, the heart is eventually slowed, apparently 
from a direct depressant action on the cardiac muscle. Cocaine 
constricts the arterioles, mainly from stimulation of the vaso- 
constrictor centre, and in the earlier stages of the poisoning 
the vessels are much contracted. This, together with the in- 
creased rate of the heart, leads to a marked rise in the blood- 
pressure. Later the pressure falls, probably from peripheral 
action. 

Respiration. — The respiratory centre in the medulla is at first 
stimulated and then depressed. Consequently, the respiration 
is primarily accelerated, but as the depression comes on, the 
amount of air inspired gradually becomes diminished, and the 
breathing grows slow, weak and irregular. Cheyne-Stokes 
respiration is frequently present, and death occurs from as- 
phyxia. 

Nervous System. Cerebrum. — The first effect is a stimula- 
tion of the higher parts of the brain, such as is caused by caf- 
feine. In animals there is increased movement, which is per- 
fectly coordinated, and in man wakefulness and mental exhilara- 
tion. All observers agree that cocaine has remarkable potency 
in increasing muscular power and removing fatigue. If the 
quantity taken is sufficiently large, the stimulation is followed 
by depression, which is often first shown in choreic movements, 
from derangement of the coordinating functions. The animal 
moves in a circle, the symptoms resembling the forced move- 
ments often seen in affections of the cerebellum. Narcosis 
ensues, and this is succeeded by convulsions, the seat of which 






COCA. 761 

has not been determined, but is supposed to be in some portion 
of the hind brain. If the paralysis is rapid, it is found that 
the convulsive stage may be absent. 

Medulla Oblongata. — The medulla is early affected, and the 
various centres are first stimulated and then depressed. 

Spinal Cord. — The cord, too, is at first stimulated, as is shown 
by exaggeration of the reflexes, and very large doses may cause 
convulsions, of spinal origin, resembling those due to strych- 
nine. It will thus be seen that the action of cocaine on the 
central nervous system consists in a descending stimulation, 
followed by depression, which successively progresses from the 
cerebrum to the spinal cord. In some cases, however, it is to 
be noted, the stage of stimulation is very short or altogether 
absent, and it has also been observed that the two stages are 
not definitely divided, so that one part of the cerebrum may 
show depression while another is still excited. With small 
doses the cerebrum chiefly is affected. 

Eye. — Cocaine, applied to the eye, causes local anaesthesia and 
pallor of the conjunctiva and iris, from vascular constriction. 
When it is applied to the conjunctiva, in considerable quantity 
and for some time, and also when it is administered system- 
ically, ocular phenomena are produced which are the same as 
those caused by stimulation of the cervical sympathetic. It is 
therefore considered that cocaine has a special action on the 
centres or terminations of this nerve, and there is reason to be- 
lieve that the stimulation to which it gives rise really affects 
both. Mydriasis is caused, though the iris still reacts to light, 
and the accommodation is impaired. The intra-ocular ten- 
sion is somewhat reduced, and the palpebral aperture is 
widened. The dilatation of the pupil differs from that due to 
atropine as regards the persistence of the reaction to light and in 
being less complete. The mydriasis is also more readily over- 
come by pilocarpine and muscarine than that caused by atro- 
pine. Either strong or weak cocaine solutions when fre- 
quently applied desiccate the corneal epithelium. 

Temperature. — Under large doses of cocaine the temperature 



762 PHARMACOLOGY AND THERAPEUTICS. 

rises, and this has been ascribed to a stimulation of the thermo- 
genetic centre in the brain. In poisoning in animals it has 
been observed that the higher the temperature, the more readily 
are convulsions produced and the more severe their character. 

Excretion. — Cocaine is eliminated in the urine and probably 
also excreted into the intestine. The quantity of urine appears 
to be sometimes increased and sometimes diminished. In some 
instances the injection of the drug has been followed by com- 
plete anuria lasting for several hours. In view of the variations 
noted, it has been suggested that the action is not a direct one 
on the kidney, but is caused merely through the changes in the 
calibre of the vessels. The effects on the vasomotor centre, 
an early stimulation and later paralysis, would account for such 
variations. The other secretions beside the urinary seem to be 
rather diminished than increased. Cocaine has some anaphro- 
disiac effect. 

Therapeutics of Coca. 

External. — A 5 to 10 per cent, solution of cocaine hydrochlo- 
ride may be injected subcutaneously as a local anaesthetic for the 
performance of small operations. In the infiltration method 
of Schleich three solutions are employed: cocaine hydrochlo- 
ride, 0.2 (strong) ; 0.1 (normal) ; or 0.01 (weak) ; morphine 
hydrochloride, 0.025; sodium chloride, 0.2; sterilized distilled 
water or saturated boric acid solution to 100. These are in- 
jected into the substance of the skin, forming wheals. This 
method requires less of the drug than when it is used subcu- 
taneously. Yet it should be borne in mind that the anaesthetic 
properties of the two weaker solutions depend largely upon the 
mechanical anaesthesia produced by injection of water, the anal- 
gesic effect of which had been previously pointed out. Solu- 
tions of cocaine hydrochloride, topically applied, are used for 
operations on the mouth, throat, teeth (4 per cent.), eye (1 to 
4 per cent.), ear, vagina, urethra and rectum (4 to 10 per cent.). 
Congestive urethral stricture may be temporarily relieved by it 
so that instruments may be passed, but it should be employed 
with great care in urethral operations. It is used on mucous 



COCA. 763 

membranes for the relief of pain in various conditions, and also 
for the abatement of inflammation. It is of service in painful 
ulcers, fissures, etc., and in pruritus of the vulva and anus, and 
is also used as an application to the nasal passages in coryza and 
hay fever. In the latter affections a powder consisting of co- 
caine, 1 ; morphine, 1 ; bismuth subnitrate, 5, may be snuffed 
into the nostrils. Ointments, bougies, and suppositories, usually 
containing 2 to 5 per cent, of cocaine, which mixes better than 
the hydrochloride, are very useful. A 15 per cent, solution has 
been injected into the gums for tooth extraction, but is hardly 
to be commended. Ophthalmic surgeons employ it very largely 
to produce local anaesthesia of the eye. If inflammation is pres- 
ent, however, anaesthesia is produced with great difficulty. 

A solution is useful for painting or spraying on the throat 
previous to laryngeal examinations. Lozenges of the hydro- 
chloride, containing .003 gm. ( J^gr.) in each, are valuable for 
painful sore throat. Often in addition each lozenge contains 
.06 gm. (1 gr.) of extract of krameria. 

Internal. — Cocaine, because of its effect in depressing the gas- 
tric sensory nerves, is sometimes employed to relieve vomiting 
in pregnancy, seasickness and other conditions. It or the fluid- 
extract of coca may be given, as a supportive and stimulant in 
low fevers, and in cases where great physical and mental 
strain is to be borne. The preparations of coca, especially the 
wine, are much used as stomachic tonics, and in the debility 
of convalescence from acute diseases. Some clinicians have 
found cocaine a remedy of the highest value in chorea, and 
state that paralysis agitans, alcoholic tremors, and senile tremb- 
ling are more favorably affected by it than by any other drug. 

Medullary Anasthesia. — Within the last few years it has been 
proposed to obtain surgical anaesthesia by injection of from 
-jlj- to^- gr. ; .006 to .012 gm. into the arachnoid space. Puncture 
is made between the third and fourth lumbar interspace of the 
spine with a specially prepared needle, as for diagnostic pur- 
poses. A few drops of the spinal fluid is allowed to escape 
and the solution is injected. Anaesthesia supervenes, gradually 



764 PHARMACOLOGY AND THERAPEUTICS. 

extending from the feet upwards, and may reach to the chest or 
even higher ; this persists for a variable time, but generally suffi- 
cient for the performance of surgical operations. This method 
of anaesthesia does not interfere with labor further than abol- 
ishing its pain. Strict asepsis must be observed. Beyond some 
nausea, vomiting and headache, after-effects are not usually 
noticed. Several deaths have now been reported as due to the 
procedure, however, so that it seems hardly likely that it will 
supplant ether or chloroform narcosis, or that it can be per- 
formed without too great risk when contra-indications exist to 
either. 

TOXICOLOGY. 

Symptoms. — Acute poisoning in quite a large number of instances has 
followed the injection of cocaine into the urethra previous to some 
operation, and sometimes occurs from the injection of the drug under 
the gums or skin. Otherwise it is not often met with. The symptoms 
vary in different individuals, but usually the patient at first becomes more 
or less excited, restless and garrulous. The pulse and respiration are 
quickened, the pupils dilated, and there are present dryness of the throat, 
headache, vertigo and confusion. There may be exaggeration of the 
reflexes, and tremors and slight convulsive movements are apt to occur. 
Later, powerful tonic or clonic convulsions may come on. The heart 
becomes turbulent in its action, and the respiration, which soon grows 
dyspnoeic in character, may be arrested during a convulsion. In other 
cases no actual convulsions may be met with, while fainting and collapse 
rapidly supervene. The patient suffers from profound cardiac and res- 
piratory depression, with tremors, and the skin is cold, cyanotic and 
clammy. Death may take place from gradual failure of the respira- 
tion, and if the patient survives he may suffer for months from tremors 
and other nervous symptoms. Out of 250 cases of accidental poisoning 
from the medicinal use of cocaine, 13 proved fatal. 

Chronic poisoning, or cocamania, is not infrequently seen. The victim 
of the cocaine habit rapidly loses flesh and sometimes suffers from faint- 
ing fits. Among the phenomena characterizing the condition are dis- 
orders of the circulatory system, insomnia, mental failure, and delusions 
not unlike those of chronic alcoholism. Visual and other hallucinations, 
generally of a disagreeable type, are often present, and one symptom 
which is regarded as pathognomonic of subacute or chronic intoxication 
with this drug is a sensation of crawling worms or insects, "cocaine 



ALPHA-EUCAINE HYDROCHLORIDE. 765 

bugs," under or on the skin. Sometimes there is delirium or acute 
mania. The central nervous system seems to undergo degeneration like 
that observed in chronic morphine poisoning. Cocaine habitues are by 
no means infrequently met with. The moral degradation is fully equal 
to that of opium-eaters. Cocaine, which is usually taken by hypoder- 
matic injection in these cases, is often employed in association with 
morphine, and the habit is sometimes acquired by those making use of 
this drug to break themselves of the morphine habit. 

Treatment. — Acute poisoning. If the drug has been taken by the 
mouth the stomach should first be evacuated by washing out or by the 
use of apomorphine. The treatment is mainly one of stimulation, and 
strychnine is especially indicated as a respiratory stimulant. Artificial 
respiration may also be called for. Amyl nitrite may be of service if 
the blood-pressure is high, and small quantities of chloroform or ether, 
by inhalation, may be required for the convulsive attacks. 

Chronic poisoning. — The habit is difficult to cure, as relapses are 
frequent. The most important point in the treatment is the withdrawal 
of the drug, though the sudden stopping of it may bring on profound 
collapse. There is little chance of a successful result unless the patient 
is confined for a considerable time in an asylum or sanitarium. 

Unofficial Preparations. 

Alpha-Eucainae Hydrochloridum. — Alpha-eucaine hydrochlo- 
ride. (Eucaine Hydrochloride. Eucaine. Alpha-eucaine hydro- 
chlorate.) 

Beta-Eucainae Hydrochloridum. — Beta-eucaine hydrochlo- 
ride. (Beta-eucaine hydrochlorate.) • 

Action of Eucaine Hydrochloride. 
The general action of eucaine, both in cold and warm-blooded 
animals, consists in a marked excitation of the entire central 
nervous system, followed by paralysis; in toxic doses going on 
to death. Small doses administered to mice and rabbits cause 
increased reflex excitability, and increased but weakened respi- 
ratory movements. Medium doses in rabbits cause repeated 
tonic and clonic convulsions. The animals lie senseless on their 
sides, with dyspnoea, opisthotonos, and finally paresis of the 
posterior limbs. These phenomena are still more marked when 
large toxic doses are administered; the convulsions return con- 



766 PHARMACOLOGY AND THERAPEUTICS. 

tinuously, and affect all the muscles of the body. The animals 
finally die when the paralysis reaches the respiratory muscles. 
When the dose is not a fatal one, the convulsions gradually 
cease, the increased reflex excitability disappears, and the pare- 
sis of the hind limbs slowly improves. The effect on the cen- 
tral nervous system is therefore at first excitant, and later, in 
toxic doses, paralyzing. The paralysis is a central one, for if 
the sciatic nerve of a frog poisoned with eucaine is exposed, 
and its peripheral end irritated with the induced current, the 
limb reacts in a normal manner. As regards its action on the 
heart and the blood-vessels, the subcutaneous and intravenous 
injection of small and medium doses slows the heart on the 
average from twenty to thirty beats per minute, but without 
otherwise modifying the beats, or increasing the blood-pressure. 
This effect on the pulse is caused by the excitation of the cen- 
tral vagus ; for section of the vagi causes an immediate increase 
of the pulse to the normal and above it, together with an in- 
crease of the blood pressure. Death occurs from paralysis of 
the respiratory centres, for the heart continues to beat for some 
time thereafter. It is claimed that eucaine solutions possess 
moderate antibacterial powers. 

Therapeutics of Eucaine Hydrochloride. 
Eucaine is used in from 1 to 5 or even 10 per cent, solutions 
for the same purposes as is cocaine. The anaesthesia comes on 
somewhat more slowly, with solutions of the same strength is 
about equal to, and its effects last about the same time as with 
the latter drug. It possesses the disadvantage of causing hyper- 
emia of mucous membranes, and in 2 per cent, solution may 
irritate the conjunctiva. A 1 per cent, solution, however, does 
not cause any disturbance. It is preferable to cocaine in that 
its aqueous solutions are permanent and can be sterilized by 
heat without decomposition. It does not cause mydriasis nor 
disturbance of accommodation, nor does it dry the corneal epi- 
thelium, and further it is relatively safer, so far as circulation 
and respiration are concerned, than cocaine. 



HOLOCAINE. j6j 

Beta-Eucaine. — In order to avoid the burning sensations, pain 
and hyperemia to which eucaine may give rise, a substance 
known as Benzoylvinyldiacetonalkamin hydrochloride, named 
Beta-eucaine (hydrochloride), a compound closely related chem- 
ically to eucaine, has been recommended. Its chemical and 
physiological properties, with the above exceptions, are the 
same. It is safe, being three and three-quarters less toxic than 
cocaine, does not affect the heart, and is unirritating. It does 
not produce, when employed in the eye, mydriasis, corneal le- 
sions, nor disturbances of accommodation. It can be sterilized 
by boiling without deterioration ; its solutions are permanent 
and do not decompose when kept. Its field is the same as that 
of cocaine, and it can be employed for the various operations 
upon the eye, nose, ears, genito-urinary tract, in minor surgery 
and dentistry, and for infiltration anaesthesia. For medullary 
anaesthesia, while the after-effects seem no greater than with 
cocaine, the analgesia is not so uniform nor lasting. Its ease 
and certainty of sterilization by boiling are in its favor, and 
some operators are strong advocates of it. It is employed in 
from y 2 to 4 per cent, (saturated) aqueous solution, but of the 
latter not more than 2 c.c. (30 HI) should be employed at one 
time, although for a prolonged operation five times this quan- 
tity may be employed. 

Unofficial Preparation. 
Holocaina. — Holocaine. (Holocaine hydrochloride. Para- 
diethoxyethenyl-diphenyl-amidine-hydrochloride.) 

Action of Holocaine. 
It is a local anaesthetic, and paralyzes the sensory nerves of 
the cornea and mucous surfaces even more powerfully than 
cocaine. It does not produce any necrosis, and has no effect 
upon the blood-vessels. It should not be used hypodermatically, 
as it is said to be about five times as toxic as cocaine. Even 
small doses cause in both frogs and warm-blooded animals con- 
vulsions which appear to be of cerebral origin. It is a muscle 



?68 PHARMACOLOGY AND THERAPEUTICS. 

poison, a I per cent, solution rapidly killing voluntary and 
cardiac muscles in the frog, and it also exerts a curare-like 
influence on the motor nerves. It is powerfully antiseptic: a 
i per cent, solution has not only an inhibitory effect upon pus 
organisms, but destroys them when they are exposed to its 
action for a certain length of time. 

Therapeutics of Holocaine. 

It is used as a local anaesthetic for the same purposes as 
cocaine; while it has some advantages over the latter, it is 
necessary that its application should be renewed in from ten to 
fifteen minutes. It is largely employed in ophthalmic practice, 
where its peculiar value lies in the rapidity of its action and 
the fact that it leaves the pupil, accommodation and intra-ocular 
tension quite unaffected. Its germicidal power is a further 
advantage, and it has a very beneficial effect on septic ulcers 
of the cornea. Holocaine is widely used also in affections of 
the nose, throat and ear and in operative procedures upon these 
parts, and no toxic effects appear to have been observed from 
its use as a local anaesthetic. A I per cent, solution is gener- 
ally employed, and it should be prepared in porcelain (not in 
glass), as this salt is very sensitive to alkalies, and even the 
small amount of alkali dissolved out of the glass on boiling a 
solution of it in a test-tube is sufficient to decompose it. 

Unofficial Preparation. 
Orthoformum. — Orthoform. (Methyl-para-amido-meta-oxyben- 
zoate.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr. 

Action of Orthoform. 
It has a similar action on the sensory nerve terminations to 
cocaine, but as its chemical composition is entirely different 
from the latter, this is the only point in which it resembles it 
in its effects. The anaesthetic quality of orthoform is appa- 
rently due to its being an aromatic derivative. The special 
feature of its anaesthetic influence is its long continuance. An- 



ORTHOFORM. 769 

sesthesia is caused for many hours, or perhaps even for days, 
by a single application of the powder to abraded surfaces, and 
the reason for this is that the drug becomes dissolved only very 
slowly, and hence remains in contact with the part for a long 
time. Occasionally it has been known to produce a necrosis. 
It is found, however, that it is unable to penetrate mucous mem- 
brane like cocaine, and on this account it produces its anaes- 
thetic effect only when it comes into actual contact with ex- 
posed nerve-ends. Therefore on sound skin or mucous mem- 
brane it has no influence, and is consequently unfit for ordi- 
nary use as a surgical anaesthetic. On account of its very 
slight solubility, and because it is also excreted very rapidly, 
it is practically non-toxic. Its insolubility renders its subcu- 
taneous use difficult, but it is stated that if it is artificially 
brought into solution and then injected, it is no less dangerous 
than cocaine. Apparently on account of its insolubility, it has 
very little influence on the system, whether applied to abraded 
surfaces or taken by the mouth, even in very large amounts. 

Therapeutics of Orthoform. 
It is commonly applied as a dusting powder or in ointments. 
In burns, ulcers, abscesses, etc., where it can reach nerve ter- 
minations, it is very efficient in relieving pain, and also exerts 
a healing influence similar to that of iodoform ; but in affections 
of the nose or throat it has very little effect unless ulceration 
be present. In ulcerative disease of the larynx if a spray con- 
sisting of a solution of 0.30 gm. (5 gr.) of orthoform in 3 
c.c. (50 ^1) each of alcohol and water is made use of, a pro- 
tective coating is deposited on the parts. Or, an emulsion of 
1 part orthoform to 4 parts olive oil may be applied to the 
larynx. Insufflation of the powder is also frequently employed 
in diseased conditions of the throat and nose. For many pur- 
poses the saturated solution of orthoform in collodion is most 
effective. Orthoform has been used with much success in gyn- 
aecological and genito-urinary practice, as well as dentistry, and, 
administered by the mouth, it is very efficient in controlling the 
50 



770 PHARMACOLOGY AND THERAPEUTICS. 

pain of ulcer or cancer of the stomach. It is of no service, 
however, in relieving headache or neuralgic conditions. It is 
sometimes employed hypodermatically to produce local anaes- 
thesia for surgical operations, it being found that after violent 
shaking in water it is divided into such small particles that they 
can be injected with a somewhat large needle. The pain caused 
by the passage into the tissues may be obviated by a prelim- 
inary injection of a small quantity of cocaine. Orthoform 
when applied to ulcers has been known to produce sloughing 
similar to that caused by pure carbolic acid, and on the skin to 
cause redness and irritation and even a decided pruritic erup- 
tion. In rare instances it is stated to have given rise to an 
erythema complicated with vesicles and to gangrenous erup- 
tions. 

^ETHYLIS CHLOKIDUM.— Ethyl chloride. (Mono-chlor-ethane. 
Hydrochloric ether.) 

Unofficial Preparation. 
Methylis chloridum. — Methyl chloride (Mono-chlor-methane.) 

Two substances used to produce local anaesthesia may be 
here considered: Ethyl chloride and methyl chloride. 

Ethyl chloride is an inflammable liquid which is even more 
volatile than ether, entering into ebullition at 12.5 C. (55 F.), 
and producing intense cold by its evaporation. It is used for 
the production of local anaesthesia and to relieve the pain of 
neuralgia, etc. It is supplied in hermetically sealed glass tubes 
having a pointed extremity, and when the end is broken off 
and the tube held in the hand, it escapes in a fine stream which 
is directed upon the part it is desired to affect. The skin should 
first be cleansed of all fat by the use of soap, followed by wash- 
ing with ether. More recently ethyl chloride has been used 
with considerable success as a general anaesthetic for short 
operations and as an anaesthetic preliminary to ether or chloro- 
form in longer operations. It acts very promptly, and is pref- 
erably employed with a special inhaler. It is claimed to be as 
safe as nitrous oxide gas. 



TONGA. 771 

Methyl chloride is also extremely volatile, producing local 
anaesthesia through the cold resulting from its evaporation. It 
is used for the same purposes as ethyl chloride. One objection 
to the use of both these substances, as well as of ether, for the 
production of local anaesthesia, is that the intense cold caused 
is sometimes as painful as the operation itself would be without 
any anaesthetic. 

Unofficial Preparation. 
Ouabainum. — Ouabain. Dose, .00013 gm.; jfa gr. 

Action of Ouabain. 

Ouabain paralyzes cardiac muscle by direct action, and when 
given hypodermatically is an emetic. It is a local anaesthetic, 
and is stated to have ten times the power of cocaine in this 
regard. 

Uses of Ouabain. 

It has been recommended as a local anaesthetic and also for 
the treatment of all stages of whooping-cough in doses of .00006 
gm. (y-oVoS 1 "-) ^ or children. As it is a very powerful drug, 
.001 gm. (^ig-gr.), when taken into the blood, being sufficient to 
kill a man, it should be used with extreme caution. 

TONGA. 

Unofficial Preparations. 
Tonga.— Tonga. Dose, 1 to 4 gm.; y 4 to 1 dr. 
Fluidextractum Tongas.— Fluidextract of Tonga. Dose, 1 to 
4 c.c; 14 to 1 fl. dr. 

Action of Tonga. 
Very little is known of the action of this drug. In large 
doses it is purgative. 

Therapeutics of Tonga. 
Tonga as a fluidextract, dose, 1 to 4 c.c. {]/ A to 1 fl. dr.), 
undoubtedly relieves some cases of intractable neuralgia. Com- 



772 PHARMACOLOGY AND THERAPEUTICS. 

bined with salicylates it is of great value for the treatment of 
so-called muscular rheumatism. 



E. Drugs Acting on the Spinal Cord. 
i. Drugs increasing the irritability of the anteria cornua. 

NUX VOMICA. 

NUX VOMICA.— Nux Vomica. (Poison Nut. Dog Button.) Dose, 
0.125 gni. (125 milligm.); 2 gr. 

Preparations. 
i. Extractum Nucis Vomicae. — Extract of Nux Vomica. 
Dose, 0.015 gm. (15 milligm.) ; y 4 gr. 

2. Fluidextractum Nucis Vomicae. — Fluidextract of Nux 
Vomica. Dose, 0.05 c.c; 1 TT\. 

3. Tinctura Nucis Vomicae. — Tincture of Nux Vomica. Dose, 
0.6 c.c; 10 Til. 

STRYCHNINA.— Strychnine. Dose, 0.001 gm. (1 milligm.) ; ^ gr. 

Preparations. 

1. Elixir Ferri, Quininae et Strychninae Phosphatum. — Elixir 
of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; 
1 fl. dr. 

2. Glyceritum Ferri, Quininae et Strychninae Phosphatum. — 

Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 1 
C.C.; 15 fll. 

3. Syrupus Ferri, Quininae et Strychninae Phosphatum. — 

Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; 
1 fl. dr. 

4. Pilulae Laxativae Compositae. — Compound Laxative Pills. 
Dose, 2 pills. 

5. Syrupus Hypophosphitum Compositus. — Compound Syrup 
of Hypophosphites. Dose, 8 C.c; 2 fl. dr. 

STRYCHNINE NITRAS.— Strychnine Nitrate. Dose, 0.001 gm. 
(1 milligm.) ; ^ gr. 



nux vomica. 773 

STRYCHNINE SULPHAS.— Strychnine Sulphate. Dose, 0.001 
gm. (1 milligm.) ; ^ T gr. 

Unofficial Preparation. 
Brucina. — Brucine. 

Action of Nux Vomica and Strychnine. 

External. — Strychnine is a very powerful antiseptic, and 
when injected subcutaneously in concentrated solution it is irri- 
tating to the tissues. Brucine is a weak local anaesthetic. 

Internal. Gastro-intestinal Tract. — Xux vomica is a sto- 
machic bitter, increasing the appetite, aiding the digestion, and 
acting generally like other agents of this class. In the intes- 
tine it is directly stimulating to the muscular coat of the bowel. 
Hence it promotes peristalsis and has a purgative action. 
Strychnine is believed to be absorbed mainly from the intestine. 

Circulation. — Strychnine, by stimulating the vaso-motor cen- 
tre, produces constriction of the arterioles, thereby causing a 
rise of blood-pressure, which is augmented by the increased 
peripheral resistance arising from the general activity of the 
muscles. The result is that the force of the heart is increased 
and the diastole lengthened. The pulse is also slowed by the 
stimulation of the vagus centre in the medulla. The direct ac- 
tion on the heart is probably less marked than has been gener- 
ally supposed. In experiments upon the excised mammalian 
heart it has been found that a small dose slows the heart and 
increases its force, while somewhat larger doses cause a slight 
acceleration, also with increased force. It is thought likely, 
however, that these effects are not sufficiently marked to be of 
therapeutic importance. Very large doses cause cardiac mus- 
cular paralysis. During the convulsions caused by the alkaloid 
the blood-pressure is raised to an extreme height, partly by the 
action on the vaso-motor centre and partly, it may be. in con- 
sequence of the blood being pressed out of the abdominal or- 
gans and the muscles by their violent contraction. Immediately 
after a convulsion the blood-pressure falls. The vascular con- 



774 PHARMACOLOGY AND THERAPEUTICS. 

striction, it would seem, affects chiefly the internal vessels, 
while, as a result probably of stimulation of vaso-dilator areas 
in the medulla, those of the skin and possibly of the muscles 
are dilated; consequently there is an afflux of blood to the ex- 
tremities and cutaneous surface. The heart is found to beat 
long after the respiration has failed, and if artificial respiration 
be maintained, may continue to do so for an indefinite period. 
Blood that is mixed with strychnine and shaken with air con- 
tains more oxygen and less carbon dioxide than ordinary blood, 
but there is no reason to suppose that strychnine, at least in 
ordinary doses, increases the oxidizing power of living blood. 

Respiration. — The respiratory centre in the medulla is stimu- 
lated directly and also reflexly by reason of the increased mus- 
cular activity. The respiratory movements are consequently 
accelerated and strengthened. As the muscles of respiration 
participate in the general convulsive seizures, however, they 
ultimately become completely exhausted, and death by asphyxia 
may occur suddenly after a spasm. In other instances the fatal 
result is due to gradual paralysis of the respiratory centre. 
Between the convulsions the breathing is usually fairly regular, 
but during their presence it is arrested by the violent contrac- 
tion of the diaphragm and the other respiratory muscles. 

Nervous System and Muscles. — The cerebrum is believed to 
be somewhat affected by strychnine, though to a less extent 
than the lower divisions of the central axis. In man the intel- 
lect and consciousness remain unaffected, but the special senses 
are rendered more acute, and the majority of investigators 
maintain that the irritability of the motor parts of the cortex 
is distinctly increased, except during a convulsion. In the 
medulla oblongata there is produced an active stimulation, fol- 
lowed by paralysis, of the respiratory, vaso-motor and vagus 
centres. While the stimulation of the vagus causes slowing of 
the pulse, this effect is more or less offset by the influence of 
the convulsions, since great muscular activity always tends to 
accelerate the heart. The clinical evidence is in favor of the 
cardiac centre's being strongly influenced. Strychnine in small 



nux vomica. 775 

amounts increases the tone of the medulla, augmenting the im- 
pulses which the medullary centres are constantly receiving. 
Consequently, the increased activity of the higher reflex areas 
may diminish or inhibit the irritability of the cord, so that the 
reflex response from the latter may be rendered more marked 
by the removal of the cerebrum and medulla oblongata. The 
most marked effect of toxic amounts of strychnine is an in- 
creased reflex irritability of the spinal cord, which is shown 
most conspicuously by the production of tetanus. After a short 
period of augmented reflex excitability, severe spasms occur, in 
which there are sudden and violent contractions of all the mus- 
cles of the body, the stronger extensor muscles generally pre- 
vailing against the flexors. In the intervals (lasting only a 
few minutes) between the convulsions there is complete relaxa- 
tion. Mammals usually die after the first few spasms, but in 
frogs, in which respiration can be dispensed with for long 
periods, the alternations of convulsions and the quiescent state 
may continue for hours or days. That these spasms are of 
spinal origin is shown by the fact that they are at least as well 
marked (if not more violent), both in mammals and frogs, 
when the brain has been destroyed or severed below the medulla 
oblongata, while destruction of the spinal cord stops them en- 
tirely. Muscle and motor nerve endings may be excluded by 
section of the nerve-trunk, which stops the convulsions : while 
sensory nerve endings may be excluded by ligating a leg, with 
the exception of the nerve, and then injecting strychnine. The 
leg will be seen to take part in the convulsions, although its 
sensory terminations are excluded from the poison. The con- 
vulsions take place if the posterior nerve-roots are cut. provided 
the proximal end is stimulated and if a probe be slowly passed 
down the spinal canal of an animal convulsed by strychnine, 
the spasms of the muscles will successively cease from above 
downward. Furthermore, the convulsions are not only spinal, 
but reflex; so that they will not occur unless some stimulus 
from without reaches the cord. After the convulsive action 
has been established the spasms may seem to occur without any 



Jj6 PHARMACOLOGY AND THERAPEUTICS. 

such stimulus, but this is not the case, for they may be induced 
by a very insignificant stimulation, as for instance, a slight 
contraction of a muscle. The conduction power of the cord 
must be enormously exaggerated by strychnine, since general 
convulsions follow upon a peripheral stimulation so slight as 
to be even imperceptible. Strychnine convulsions are abolished 
by curare, for the latter has the effect of blocking impulses 
from the cord to the muscles. The exact location of the action 
of strychnine in the spinal cord has not as yet been determined. 
In the present state of our knowledge it may be said that the 
drug removes resistances which normally oppose the passage 
of impulses somewhere between the point at which the centri- 
petal fibres enter the cord and the motor cells, but does not 
apparently act upon the motor cells of the anterior horn, nor 
upon those of the posterior root ganglion. It is consequently 
regarded as most probable that it affects chiefly some cells in- 
tercalated between these structures. Strychnine does not seem 
to have any direct action on the voluntary muscles. While 
very small quantities have the effect of increasing their tone, 
this is attributable to action on the spinal cord and not on the 
muscle fibres. Neither muscles nor afferent nerves are af- 
fected by the largest doses of the poison. Under large quanti- 
ties the motor nerve endings are paralyzed by the direct action 
of the drug, but this effect is probably only to be observed in 
certain species of frogs, in which these terminations are para- 
lyzed before the central nervous system. In mammals central 
paralysis destroys life before paralysis of the nerve endings is 
induced, though towards the end of a case of poisoning their 
functional activity is said to be depressed. 

Special Senses. — Mention has been made of the influence of 
strychnine in increasing the acuteness of the special senses. 
This effect is produced by small doses, and is believed to be 
probably a cerebral action, although it is contended by some 
that it is due to alterations in the peripheral organs. While the 
acuteness of the hearing and the sense of smell is apparently 
increased, the effect of the drug is most decidedly shown in the 



NUX VOMICA. "/J? 

sense of touch, the delicacy of which is markedly augmented, 
and in the vision. The field of the latter is widened, especially 
for blue, and differences can be recognized between shades of 
color which ordinarily seem identical ; while in certain condi- 
tions of amblyopia light is said to be rendered much more 
distinct. 

Metabolism. — In consequence of the violent contractions of 
the muscles throughout the body, there is naturally an increased 
oxidation, and the amount of oxygen absorbed and of carbon 
dioxide excreted by the lungs shows a corresponding augmen- 
tation. This increased excretion of carbon dioxide is found, 
however, to occur, though to a less extent, even when the skele- 
tal muscles have been curarized, and it is concluded, therefore, 
that it is due in part to the contraction of the muscular coats 
of the blood-vessels and possibly to the increased metabolism 
of the central nervous system. There is an increased produc- 
tion of heat in consequence of the increased oxidation of the 
tissues, but this is offset, to a varying degree in different ani- 
mals, by an augmented skin dissipation. While, however, the 
internal temperature may be even slightly lower than normal, 
the cutaneous temperature generally shows a considerable rise 
on account of the afflux of blood to the surface. 

Elimination. — Strychnine, which is rapidly absorbed, is ex- 
creted in part unchanged, principally in the urine, but also in 
the saliva, sweat and bile. The excretion, although it com- 
mences promptly, is very prolonged, usually continuing for a 
week or more. Part of the strychnine is destroyed, probably 
through oxidation, in the tissues. The characteristic symptoms 
of the poison are found to be very much less marked when the 
animal is placed in an atmosphere of oxygen, and it is also 
stated that if the dose (though large enough to prove fatal 
under ordinary circumstances) is injected into the leg of the 
animal, but prevented from reaching the circulation for an 
hour, it has absolutely no effect. Strychnine is said to be re- 
tained for a long time in the liver and central nervous system. 

The action of Brucine, while in general similar to that of 



yy8 PHARMACOLOGY AND THERAPEUTICS. 

the more powerful alkaloid, is distinguished from the action 
of strychnine in showing a greater tendency to produce paraly- 
sis of the central nervous system and a more marked curare- 
like action. A 5 to 10 per cent, solution of chemically pure 
brucine is stated to produce rapid loss of sensibility when ap- 
plied to the buccal mucous membrane in man, while a 20 per 
cent, solution is capable of exciting a decided local anaesthetic 
effect when applied to the skin. 

Therapeutics of Nux Vomica and Strychnine. 

External. — On account of its very pronounced toxic charac- 
ter, strychnine is never employed for antiseptic purposes. 

Internal. G astro -intestinal Tract. — Tincture of nux vomica 
is an admirable stomachic bitter, and is especially useful in 
cases where impairment of digestion is due to enfeeblement of 
the general system. 1.20 c.c. (20 ^l) of it in a wineglass of 
hot water will frequently at once check gastro-intestinal fer- 
mentation. Nux vomica may often be combined with good 
effect with diluted hydrochloric acid and some such bitter as 
gentian or cinchona. In the gastric catarrh and morning vom- 
iting of drunkards it is considered as next in value to arsenic. 
It may be given advantageously with mineral acids. In cases 
of constipation in which the contractile power of the muscular 
coat of the intestine is feeble, in consequence, like the impaired 
digestion referred to, of general weakness of the system, it is 
of great service in promoting peristalsis by its action on the 
intestinal muscle. In instances of this kind it is commonly 
associated, in pill or otherwise, with remedies especially appro- 
priate to the special condition of the patient, as, for instance, 
with preparations of iron in cases of anaemia. It has sometimes 
proved useful in epidemic dysentery, and in some epidemics 
of cholera strychnine, combined with opium and mineral acids, 
has appeared to ward off the stage of collapse. Nux vomica 
has been advised in a variety of indefinite conditions of depres- 
sion and general want of tone, in which it is difficult to say 
whether the results are to be ascribed to its effect in improving 



nux vomica. 779 

the appetite and digestion or in increasing the activity of the 
spinal cord and medulla. 

Circulation. — Nux vomica and strychnine are useful as car- 
diac stimulants, especially in cases of disease of the heart in 
which digitalis is contra-indicated. They are sometimes com- 
bined with other cardiac stimulants, such as caffeine. In in- 
stances of urgent danger from failure of the heart's action in 
the course of chronic cardiac disease and other affections the 
prompt use of strychnine by hypodermatic injection not infre- 
quently proves of the greatest service. 

Respiration. — Strychnine is an excellent respiratory as well 
as cardiac stimulant. It may be given with expectorants when 
there is an abundant mucous secretion and little effort is made 
for its expulsion, but is contra-indicated in dry constant cough 
with small expectoration. It is especially valuable when in 
bronchitis and other thoracic diseases the respiration has be- 
come weak and shallow. In pneumonia it is extremely useful 
when death is imminent from dilatation of the right heart. In 
this condition it should be administered hypodermatically and 
at frequent intervals. In many cases of poisoning also, espe- 
cially by agents tending to cause failure of the respiration, its 
employment in judicious doses by this method serves a useful 
purpose on account of its pronounced stimulating action upon 
the respiratory centre in the medulla. Strychnine has been 
recommended in the night-sweats of phthisis, on the supposi- 
tion that these are due to imperfect respiration during sleep. 

Nervous System. — In nervous diseases strychnine has been 
used to quite a large extent, and often without proper discrim- 
ination. Consequently, the results obtained have not always 
been of a satisfactory character. On account of its action on 
the central nervous system, it is prescribed in different forms 
of paralysis, and some restitution of function, or, it may be, 
some retardation of the disease, may attend its use in many of 
them. It is found that the cases in which it is of the most 
benefit are those in which there is present no appreciable or no 
well-marked central anatomical lesion, as in hysterical, neuras- 



78O PHARMACOLOGY AND THERAPEUTICS. 

thenic, diphtheritic and syphilitic paralyses, and in paralysis 
due to such poisons as lead and arsenic. Little is to be ex- 
pected from it when sclerosis exists, and in paralysis resulting 
from cerebral apoplexy it may possibly prove injurious in con- 
sequence of the congestion of the brain and tendency to recur- 
rence of the haemorrhage caused by its action in increasing the 
blood-pressure. It may, however, be sometimes given with ad- 
vantage in hemiplegia when sufficient time has elapsed to per- 
mit repair of the damage done by the extravasation, and is of 
most service when the paralyzed members are completely re- 
laxed. When the paralysis has existed so long that the muscles 
have undergone fatty degeneration it is quite useless. Strych- 
nine is always contra-indicated in paralytic cases when head- 
ache, vertigo and tinnitus aurium are present. It sometimes 
proves useful in the nocturnal enuresis of children, as well as 
of incontinence of urine in adults, and this has been attributed 
to the increased tone of the sphincters resulting from aug- 
mented excitability of the spinal cord. Apparently on account 
of the action of the cord, it has also been used as an emmena- 
gogue and as an aphrodisiac in impotence. Combined with the 
fluidextract of ergot, tincture of nux vomica has been recom- 
mended as a remedy for post-partum haemorrhage, and the neu- 
ralgic form of dysmenorrhcea may sometimes be cured by nux 
vomica given between the menstrual periods. 

Brucine, in 5 per cent, solution, has been found to give great 
relief as a local application in inflammations about the external 
ear, and in stronger solution in the itching of chronic pruritus. 

TOXICOLOGY. 

Symptoms. — The time of the appearance of the symptoms will depend 
largely upon individual differences and upon the manner of introduction. 
If the poison is taken by the mouth, the promptness of its action will be 
affected by the condition of the stomach, whether empty or full, and by 
the nature of the food, if any is present. If subcutaneous injection has 
been employed, the time will be affected somewhat by the place of 
introduction. Strychnine will act more rapidly than tincture of nux 
vomica, and both of these more quickly than pills. The symptoms do 



NUX VOMICA. /S I 

not often develop in less than fifteen minutes, and are not generally 
delayed beyond half an hour, but have been known not to appear for 
nearly two hours. If the dose is within therapeutic limits and yet 
sufficient to produce an ontoward effect, the first symptom is likely to be 
a feeling of uneasiness with a heightened reflex irritability, and this 
may be followed by muscular twitching in some part of the body. 
When a large dose has been taken, with or without a preliminary sense 
of impending suffocation convulsive movements begin, which have 
the effect mechanically, of causing the patient to cry out or shriek, and 
they are very quickly followed by the characteristic spasms, which now 
set in with great violence. These are at first clonic and then tonic. 
Opisthotonos results from the extensor muscles overcoming the flexors, 
and the feet are curved inward. The spasms then again become clonic, 
and soon an intermission ensues. Suddenly the convulsions start up 
again, and there is thus an alternation of the convulsive attacks and 
remissions. During the latter there is complete muscular relaxation 
and general depression in the place of stimulation. With each succes- 
sive attack the symptoms increase in violence. The patient often rests 
on his head and feet, the remainder of his body being arched above the 
bed or floor. The face becomes livid and the eyeballs staring, while 
the chest and abdomen are stiff as boards. The contractions of the 
facial muscles occasion risus sardonicus, the patient grinning in a 
ghastly manner, but those of the jaw are not affected till towards the 
last. This aids in distinguishing strychnine poisoning from tetanus, 
in which the muscles of the jaw are implicated very early. Other 
diagnostic marks of tetanus, as contrasted with it, are the slower 
development of the symptoms and the continuous muscular rigidity ; 
for while between the paroxysmal exacerbations there is some diminu- 
tion of this, there is never complete relaxation, as in strychnine poison- 
ing. During the attack (in strychnine poisoning) the pulse is very 
rapid, and the sight, hearing and sense of touch become abnormally 
acute. The patient is entirely conscious, and usually suffers excruciating 
pain, though in exceptional instances the asphyxia produces more or less 
anaesthetic effect. The interference with circulation and the pressure 
on the abdominal viscera, aided by the stimulation of the medullary 
centres, may give rise to vomiting and purging. The respiration during 
the attack is at first labored and dyspnceic, and then is temporarily ar- 
rested by the spasmodic contraction of the diaphragm. Foaming at the 
mouth may occur in consequence of the interference with respiration, 
and the asphyxia resulting from the latter induces cyanosis, dilatation of 
the pupils, and eventually coma. In the intermission the patient lies 



782 PHARMACOLOGY AND THERAPEUTICS. 

exhausted, and covered with a cold sweat. The slightest noise or touch, 
or even a bright light, is likely to bring on a convulsive seizure, which 
may jerk the patient out of bed. The number of seizures varies in 
different instances, but three or four are usually fatal ; the patient suc- 
cumbing to asphyxia and exhaustion. The smallest dose of strychnine 
known to have proved lethal is .03 gm. (Y 2 gr.). Post-mortem. As in 
other conditions characterized by violent convulsions, there is early and 
often persistent rigor mortis. The appearances are those due to 
asphyxia and the convulsions : venous engorgement of the internal 
organs and, generally, hyperemia of the central nervous system, with 
small haemorrhages. Quite rarely there is also hyperemia of the 
mucous membrane of the gastro-intestinal tract. 

Treatment. — Give emetics (p. 175), particularly apomorphine hydro- 
chloride hypodermatically, or wash out the stomach if the patient is 
seen early enough for the passing of the tube not to cause spasm. 
Lavage may be practised with solution of potassium permanganate, as 
in cases of opium poisoning, but it is not so effective here. If very 
violent convulsions are already present, evacuation of the stomach, as 
a rule, should be avoided, as either emetics or the stomach-pump will 
have the effect of starting the spasms. Both potassium permanganate 
and iodine are chemical antidotes, and when one of these is employed, 
it is not so necessary to empty the stomach. When a fatal dose has been 
taken, however, the chances are that neither evacuation or any chemical 
antidote will be of service, for by the time the physician can arrive 
sufficient of the poison will probably have been absorbed to render 
both useless. Chloroform is the best physiological and most practical 
antidote, and it has the special advantage that its action can be very 
largely controlled. Chloral may be useful, and is often advised, but 
is open to the objection that with it there is always the risk that its para- 
lytic effects may coincide with those of the strychnine, and thus increase 
the patient's danger. Both chloral and morphine are antidotal to strych- 
nine as regards the effect on the cerebrum, but this is of little importance, 
while morphine may only add to the gravity of the symptoms by in- 
creasing the reflex excitability of the spinal cord and by its depressing 
effect on the respiration. Although calabar bean and gelsemium are 
theoretically more perfect physiological antagonists, since both depress 
the anterior cornua, they are practically of very little value in strychnine 
poisoning. Other measures which have been recommended are the 
administration of large doses of potassium bromide per rectum and the 
use of amyl nitrite inhalations. If the case is seen early, the employ- 
ment of tannin in large quantities may be of service, as the insoluble 



CALABAR BEAN. 783 

tannate is formed in the stomach. This should be gotten rid of, how- 
ever, as soon as possible, as it becomes broken up by the action of the 
gastric juice, and the strychnine is then rapidly absorbed. It is claimed 
as a result of animal experiments that the application of external heat 
decreases the mortality. Artificial respiration, as well as the inhalation 
of oxygen, should usually be begun early. 

2. Drugs which depress the activity of the anterior cornua. 

CALABAR BEAN. 

PHYSOSTIGMA.— Physostigma. (Calabar Bean.) Dose, 0.100. 
gm. (100 milligm.) ; iy 2 gr. 

Preparations. 

1. Extractum Physostigmatis. — Extract of Physostigma. 
Dose, 0.008 gm. (8 milligm.); y 8 gr. 

2. Tinctura Physostigmatis. — Tincture of Physostigma. 
Dose, 1 c.c; 15 n\. 

PHYSOSTIGMINE SALICYLAS. — Physostigmine Salicylate. 
(Eserine Salicylate.) Dose, 0.001 gm. (1 milligm.) ; i gr. 

PHYSOSTIGMINE SULPHAS.— Physostigmine Sulphate. (Eser- 
ine Sulphate.) Dose, 0.001 gm. (1 milligm.); ^ gr. 

Action of Calabar Bean. 

External. — A strong solution of physostigmine is said to have 
the effect of slightly diminishing the functional activity of mo- 
tor and sensory nerves, while, applied to the conjunctiva, it 
causes contraction of the pupil, myopia, dimness of vision, and 
other symptoms. 

Internal. Alimentary Tract. — Physostigmine has the effect 
of increasing the secretions of the glands, especially the sali- 
vary, mucous, lachrymal, sweat, and pancreatic, and this is due 
to its stimulating action on the terminations of the secretory 
nerves in the gland-cells. It thus acts on the same point as 
atropine, but in an exactly opposite manner. After the drug 
has been absorbed, therefore, there is usually an augmented 
flow of saliva, but the secretion may be inhibited or soon 
checked by the contraction of the arterioles caused, and the 



784 PHARMACOLOGY AND THERAPEUTICS. 

consequent insufficient nutrition of the gland cells. In the 
stomach and intestine it induces a marked increase in peristal- 
sis, in consequence, it is believed, of its action on the nerve end- 
ings in the muscular coats of these viscera, and consequently, 
if the dose is not too small, vomiting and purging are caused. 
The powerful contractions to which it gives rise are of the same 
general character as those produced by pilocarpine and mus- 
carine, but it is found to differ from them in causing these 
movements after small quantities of atropine, while larger doses 
of atropine again stop the contractions set up by physostigmine. 
The peristaltic movements culminate in a tetanic contraction 
of the muscular walls, which prevents the passage onward of 
the contents of the viscera. 

Unstriped Muscle. — On unstriped muscle in many parts of 
the body physostigmine has the same action as in the gastro- 
intestinal tract. It thus probably induces contraction not only 
of the iris, but of the bronchial tubes, spleen, uterus, ureters, 
and the gall and urinary bladders. It is also said by some to 
affect the arterioles in the same way, but proof is lacking that 
it causes contraction of their muscular coats by stimulating the 
vasomotor terminations in them. 

Circulation. — In consequence of the violent contractions of 
the stomach and intestine, which expel the blood from a very 
large area, and also in part, it is supposed, of a stimulation of 
the vasomotor centre in the medulla, there is a considerable 
rise in the blood-pressure. The contraction of the cardiac mus- 
cle is strengthened in frogs. This is denied as regards mam- 
mals, but some reliable investigators claim to have demonstrated 
it in experiments on dogs. However this may be, the pulse is 
slowed by physostigmine, and this is believed to be due to its 
direct action on the heart muscle rather than to any inhibitory 
interference, since slowing occurs even after large amounts of 
atropine. The amplitude of the cardiac movements, whether 
due to a strengthening of the contractions or to the slow 
rhythm, is afterwards diminished, and in the frog large doses 
cause arrest of the heart in systole. The rise in blood-pressure 



CALABAR BEAN. 785 

is also succeeded by a fall, and this is ascribed to paralysis of 
the vaso-motor centre. If large quantities of the alkaloid are 
injected, there is an immediate fall in the blood-pressure, and 
this is accompanied by a further slowing of the pulse. In the 
frog physostigmine, by reason of its effect in increasing the 
irritability of the cardiac muscle, is capable of starting a heart 
which has been stopped by muscarine. 

Respiration. — The respiration, which is at first quickened and 
strengthened, soon becomes retarded and dyspnceic, and death, 
which is due to paralysis of the respiratory centre, takes place 
from asphyxia. The primary acceleration may be due in part 
to stimulation of the sensory terminations in the lungs and 
partly to central stimulation. The subsequent dyspncea is no 
doubt owing in some measure to spasm of the bronchial mus- 
cles, as well as to depression of the respiratory centre in the 
medulla. 

Nervous System. — It is not known positively whether or not 
any general stimulation of the central nervous system is caused 
by physostigmine, but the primary quickening of the respira- 
tion, as well as the changes in the blood-pressure, points 
strongly towards this. As regards the cortex, it is still unde- 
termined whether the collapse met with in severe poisoning is 
preceded by a stage of slight stimulation. There is no question 
as to the drug's causing central depression. Whether this be- 
gins in the spinal cord and medulla, and only spreads to the 
cerebrum after large doses, is unknown, and some observers 
hold that the higher centres are depressed earlier than the lower 
ones. In man, however, at least, the consciousness remains 
unimpaired after the respiration and muscular power have be- 
come seriously affected ; indicating that some of the higher 
cerebral areas preserve their functions after others have been 
weakened. In the medulla, as has been mentioned, the respira- 
tory and vaso-motor centres eventually become paralyzed. Re- 
flex activity is inhibited in consequence of depression of the 
anterior cornua of the spinal cord, as may be seen when phy- 
sostigmine is applied directly to the cord. At first such activ- 
5i 



786 PHARMACOLOGY AND THERAPEUTICS. 

ity is slightly increased, but this is the result of irritation, such 
as may be caused by almost any substance, and there soon suc- 
ceeds a total abolition of reflex excitability. Subsequently 
there is paralysis of the posterior portion of the cord also, with 
diminution of cutaneous sensibility. 

Muscles and Nerves. — In mammals muscular twitchings are 
caused by large amounts of physostigmine, and constitute one 
of the most characteristic features of the poisoning. They are 
also observed in frogs, but much more rarely. In some in- 
stances they are so pronounced in warm-blooded animals as to 
simulate convulsions, but are distinguished from the latter in 
not involving the whole of a muscle at one time. This phenom- 
enon is probably attributable to the action on the motor nerve 
terminations, though some hold that it is due to direct action 
on the muscle. 

Eye. — Although the application of a solution of physostig- 
mine to the conjunctiva always causes the pupil to contract to 
its smallest diameter, this effect is not invariably observed in 
systemic poisoning. In man, however, some contraction is gen- 
erally produced. Such a variation points to its being due to 
changes in the local mechanism, and there is every reason to 
suppose that it is caused by a stimulation of the ends of the 
motor fibres in the sphincter, such as is seen in unstriped mus- 
cle elsewhere. The action of physostigmine on the eye resem- 
bles that of muscarine, except that it antagonizes atropine much 
more completely. By its effect on the motor nerve termina- 
tions in the ciliary muscle it causes spasm of accommodation, in 
addition to the contraction of the pupil from its influence on 
the iris, and in consequence of the myosis there results a 
diminution of intra-ocular pressure. Associated with these 
phenomena, especially when they are decidedly pronounced, 
there are apt to occur some twitching of the lids, dimness of 
vision, and supra-orbital pain. 

Excretion. — Physostigmine is readily absorbed and is elim- 
inated chiefly in the urine, though traces of it have been found 
in the bile and saliva. The action of the alkaloid is much more 



CALABAR BEAN. 787 

constant than that of calabar bean itself, and this may be be- 
cause the effects of the other active principles in the crude drug 
interfere to some extent with those of the physostigmine. 

Therapeutics of Calabar Bean. 

Unstriped Muscle. — Calabar bean has been used to a limited 
extent in affections in which its property of stimulating invol- 
untary muscle may be availed of. It has a certain value in 
atony of the bladder and intestines and in catarrh of the bow- 
els, and is sometimes given in purgative pills to stimulate the 
muscular layer of the intestine. Combined with nux vomica, 
it has been employed with advantage in gastric and intestinal 
dilatation. It has been especially recommended for the trouble- 
some flatulence of women at the time of the menopause, which 
is ordinarily associated with a paretic state of the muscular coat 
of the bowel, and it is stated that with the relief afforded to 
the flatulence there usually comes relief to the headache, ver- 
tigo and morbid fancies so often attending it. In chronic bron- 
chitis with deficient power of expectoration, bronchial asthma. 
and emphysema it may be of service in promoting the expul- 
sion of mucus by its influence over the muscular fibres in the 
bronchial tubes. 

Central Nervous System. — Calabar bean has been quite 
largely employed in the treatment of tetanus, but as a consider- 
able number of cases of this disease show a tendency to spon- 
taneous recovery, it is difficult to determine its real value. 
About one-half the cases in which it has been used are said to 
have been reported cured, and it is possible that this proportion 
might have been larger if sufficient attention had been paid to 
the quality of the drug employed and to the mode of administra- 
tion. It has been advised by competent authority always to 
commence the treatment by a subcutaneous injection and to 
repeat such injection until the system is decidedly affected: 
then to administer the remedy by the mouth in doses three 
times as large as those employed hypodermatically. Instead 
of the bean, it is better to employ physostigmine sulphate. 



788 PHARMACOLOGY AND THERAPEUTICS. 

Doses of .002 gm. (^i_gr.) may be given hypodermatically and 
frequently repeated, the condition of the patient in the mean- 
while being watched with great care. This remedy has been 
resorted to in trismus neonatorum and other spasms, but with 
only moderately good results. It has also been extensively 
tried in epilepsy and chorea, but in most cases has proved of 
little service and in others has seemed positively deleterious. 
Physostigmine has been given as an antidote for strychnine 
poisoning. 

Eye. — A solution of physostigmine salicylate (i or 2, to 
water, 480) is dropped in the eye to break up adhesions of the 
iris, to diminish intra-ocular tension, and to prevent prolapse of 
the iris after wounds, or ulcers of the cornea. It is also em- 
ployed in glaucoma, in paralysis of the iris and ciliary muscles, 
and to prevent the entrance of light into the eye in photophobia. 
It is useful when for any reason it is desired to rapidly over- 
come atropine mydriasis, but as it is less powerful than atro- 
pine, a larger amount will be required for this purpose than it 
took of atropine to produce the contraction of the pupil. 

ANTAGONISM. 
It will be observed that in its action on the pupil and on involuntary 
muscle generally, on secretion, on the heart, and on respiration, physos- 
tigmine is antagonistic to atropine. In its action on the spinal cord and 
respiratory centre it is antagonistic to strychnine. 

GELSEMIUM. 

GELSEMIUM.— Gelsemium. (Yellow Jasmine.) Dose, 0.065 (65 
milligm.) ; 1 gr. 

Preparations. 

Fluidextractum Gelsemii. — Fluidextract of Gelsemium. Dose, 
0.05 c.c; 1 TT1. 

Tinctura Gelsemii. — Tincture of Gelsemium. Dose, 0.5 c.c; 

8 m- 

Unofficial Preparation. 
Gelseminae Hydrochloridum. — Gelsemine Hydrochloride. 
(Gelsemine Hydrochlorate.) Dose, 0.0003 gm.; ^0 S 1 - 



GELSEMIUM. 789 

Action of Gelsemium. 

External. — If a solution of gelsemium or either of its alka- 
loids is dropped into the eye, it causes momentary smarting and 
hyperemia of the conjunctiva together with rapid dilatation of 
the pupil and paralysis of accommodation. 

Internal. — The action of gelsemium is essentially the same 
as that of gelseminine, which is much the more powerful of its 
two alkaloids. It usually has no effect on the alimentary tract, 
though in poisoning by it attempts at vomiting are observed in 
some animals. 

Circulation. — Almost the only appreciable effect it has upon 
the circulation is to induce paralysis of the inhibitory mechan- 
ism of the heart. Very little change is observed in the blood- 
pressure in animals, even after large amounts, if artificial res- 
piration is maintained after the failure of the natural respira- 
tion. 

Respiration. — Gelsemium powerfully depresses the respira- 
tion, and when taken in toxic doses causes death by asphyxia. 
The failure of the respiration is probably due to paralysis of 
the respiratory centre, though it seems likely that partial pa- 
ralysis of the nerve endings in the respiratory muscles may be 
a contributory cause. Before death the temperature falls, and 
the skin is covered with a cold sweat. 

Nervous System and Muscles. — The action of gelseminine in 
general resembles in some respects that of coniine, but it differs 
from the latter in not causing any increase in arterial tension 
and in having a more depressant action on the central nervous 
system. The respiratory centre in the medulla oblongata, as 
has been mentioned, is apparently paralyzed. The higher cere- 
bral functions and the sense of pain remain unimpaired until 
just before death. Gelseminine in poisonous amounts causes 
loss of coordinating power and extreme muscular weakness, 
with marked tremor when any movement is attempted. The 
animal falls to the ground and is presently unable to raise even 
its head, while the tremors, which are ascribed to the action on 



790 PHARMACOLOGY AND THERAPEUTICS. 

the nerve terminations, as in the respiratory muscles, become 
still more pronounced. The muscles, while not being com- 
pletely paralyzed, are incapable of a continued contraction, in 
consequence of the failure of the nerve endings to transmit 
enough impulses for the purpose, and the interruptions of the 
contractions no doubt furnish the explanation of the tremor. 
Reflex excitability for the most part remains unaltered. In the 
frog the injection of gelseminine produces feebleness and slow- 
ness of movement, followed by a partial paralysis of the motor 
nerve endings in striated muscle. If the dose is sufficiently 
large, the animal is found to lie perfectly motionless and unre- 
sponsive to any form of stimulation, just as if poisoned by 
curare. It is stated that the contractions of the heart are unaf- 
fected by stimulation of the vagus, apparently because the gan- 
glionic connections along the course of the inhibitory fibres are 
paralyzed by gelseminine in the same way as by nicotine, while, 
on the other hand, the terminations of the inhibitory fibres in 
the cardiac muscle seem to retain their function, since musca- 
rine continues to weaken and slow the heart, as under ordinary 
conditions. 

Gelsemine is entirely devoid of action on mammals, but in 
the frog has an action similar to that of strychnine, increasing 
the reflex excitability of the spinal cord and inducing tonic 
spasms, and in large quantities paralyzing the motor nerve end- 
ings in muscle. 

Eye. — The effects of the local application of gelsemium have 
already been referred to. The mydriasis is less complete and 
less persistent than that occasioned by atropine, but is thought 
to be due to the same cause, paralysis of the terminations of 
the motor oculi nerve. In general poisoning by it marked 
dilatation of the pupil does not occur until quite late. Distur- 
bance of vision, followed by diplopia and ptosis is not infre- 
quently observed after gelsemium, and these effects have been 
attributed to paralysis of the ocular muscles. 



MUSCARINE. 791 

Therapeutics of Gelsemium. 
At one time gelsemium was employed as a circulatory de- 
pressant, but is not now used in this way, since its other effects 
are so harmful. Nor is it any longer prescribed for convulsive 
diseases, as tetanus, whooping-cough, chorea, etc., as it was 
found not to do any good. It is often successfully used for 
neuralgia and migraine, though how it acts is quite uncertain. 
For these the tincture may be given, or the following combina- 
tion : Gelsemine hydrochloride, .0003 gm. (-^J^gr.) and butyl 
chloral hydrate, 20 gm. (3 gr.), made into a pill with mucilage. 
One pill should be given every two hours until the pain is re- 
lieved. Gelsemium seems to be especially efficacious in neural- 
gia of the facial branches of the trigeminus. It is occasionally 
used locally to dilate the pupil and paralyze accommodation, 
and it has the advantage that its influence passes off rapidly. 
A convenient method of applying it is in gelatin discs, each con- 
taining .00013 gm. (-5-J-0 gr.) of gelsemine hydrochloride. Gel- 
semium has been employed with success in the treatment of 
some cases of eczema and pruritus. It is advised that .18 to 
.60 c.c. (3 to 10 HI) of the tincture should be taken every two 
or three hours until some of the characteristic effects of the 
drug appear. The tincture has also been used in Meniere's 
disease, in doses of 0.60 c.c. (10 Tit) three times a day, and to 
arrest attacks of bilious colic, in doses of 0.30 c.c. (5 TU) every 
quarter of an hour. Gelsemium has sometimes proved of ser- 
vice in torticollis, rigid os in labor, after-pains, spasmodic dys- 
menorrhea, haemoptysis, laryngismus stridulus, asthma and 
whooping-cough, and as an antispasmodic in coughs in general. 

MUSCARINE. 

Unofficial Preparation. 
Muscarina.— Muscarine. Dose, 0.008 to 0.12 c.c; y 8 to 2 TH.. 

Action of Muscarine. 
Muscarine in its action somewhat resembles calabar bean 
and pilocarpine, and it is antagonistic to atropine. It produces 



792 PHARMACOLOGY AND THERAPEUTICS. 

free salivation, abundant perspiration, diminution of the force 
and frequency of the pulse, dyspnoea, paralysis and finally death. 
The pupil is contracted; dilating, however, before death. The 
cardiac diastole is prolonged, owing to action upon the inhibitory 
nerves. The muscles of the intestines and bladder are mark- 
edly contracted. The abdominal secretions are increased. 

Therapeutics of Muscarine. 
Although it has been but little employed in medicine, musca- 
rine is likely to be useful in intestinal torpor, duodenal catarrh, 
and in inflammatory effusions and exudations. As it produces 
contraction of pulmonary capillaries, it is indicated in pulmo- 
nary haemorrhage and incipient pulmonary congestion. 

BROMINE. 
BROMUM.— Bromine. 

Preparations. 
i. Potassii Bromidum. — Potassium Bromide. Dose, 1 gm.; 
15 gr. 

2. Sodii Bromidum. — Sodium Bromide. Dose, 1 gm.; 15 gr. 

3. Ammonii Bromidum. — Ammonium Bromide. Dose, 1 gm.; 
15 gr. 

4. Lithii Bromidum. — Lithium Bromide. Dose, 1 gm.; 
15 gr. 

5. Calcii Bromidum. — Calcium Bromide. Dose, 1 gm.; 15 gr. 

6. Zinci Bromidum. — Zinc Bromide. Pose, 0.125 gm. (125 
milligm.) ; 2 gr. 

7. Strontii Bromidum. — Strontium Bromide. Dose, 1 gm. 
15 gr. 

Unofficial Preparations. 
Rubidii Bromidum. — Rubidium Bromide. Dose, 0.30 to 4 
gm.; 5 to 60 gr. 

Rubidii et Ammonii Bromidum. — Rubidium and Ammonium 
Bromide." Dose, 0.30 to 4 gm.; 5 to 60 gr. 



BROMINE. 793 

Action of Bromine. 

Bromine closely resembles chlorine in its effects on the 
system. 

Therapeutics of Bromine. 

It is at present very little used in medicine. Locally it has 
been employed with success as a caustic in hospital gangrene, 
chancre and carcinoma uteri, but its escharotic action is at- 
tended with great pain. The vapor of bromine with alcohol 
(i to 64) is sometimes used for inhalation in coryza and hay- 
asthma. 

Action of the Bromides. 

External. — Potassium, sodium and other bromides, locally 
applied in solution, are slightly sedative to mucous membranes, 
lessening the reflex excitability, especially of the pharynx. 

Internal. Alimentary Canal. — Administered in bulk or con- 
centrated solution, they induce salivation and thirst, and if the 
amount is large, gastric irritation with nausea and vomiting. 
Occasionally diarrhoea is caused by concentrated solutions 
reaching the intestine. These irritating effects are probably 
due for the most part to the withdrawal of fluid from the 
mucous membranes, as in the case of sodium chloride, and are 
not observed when the bromides are given in dilute solution. 
It has also been pointed out that bromides may disorder the 
stomach by so decreasing reflex action that the proper secre- 
tion of gastric juice and the digestive process do not take place 
with sufficient rapidity, and that for similar reasons they may 
cause constipation. 

Nervous System. — They have a direct effect upon the central 
nervous system, that of the potassium salt being most marked 
because with it the bromide action is supplemented by the de- 
pressant action of the base. The action consists in a depres- 
sion rather than an abolition of function. In man the bromides 
induce a diminution of mental activity in general, but this is 
affected in some respects more than others. Thus, the percep- 
tion is but little impaired, while the appreciation apparently 



794 PHARMACOLOGY AND THERAPEUTICS. 

becomes decidedly defective, so that while stimuli reach the 
brain much as usual, they do not seem to be adequately appre- 
hended. External objects are perceived, but arouse no interest 
in the patient, and frequently this state of apathy passes into 
drowsiness and sleep. The sleep, however, is never very deep 
and is not refreshing, while for several hours after waking the 
patient is apt to be more or less affected with mental confusion. 
Before slumber comes on there are observed fatigue, lassi- 
tude, disinclination for exertion, and often muscular weakness. 
There is also a marked diminution in reflex activity. Thus, 
the irritation of the mucous membranes of the genito-urinary 
tract is less liable to set up reflex movements, tickling of the 
fauces does not induce nausea, and after very large doses the 
conjunctiva may sometimes be touched without causing wink- 
ing. In some instances the general cutaneous sensibility is also 
diminished, and after large doses there may be more or less 
complete anaesthesia, which extends to the skin. In addition 
to the ordinary reflexes, some special functions, as the respira- 
tion and the sexual instinct, are depressed. The depression of 
the spinal reflexes caused by the bromides renders them antag- 
onistic to strychnine, so that in bromidized animals this alka- 
loid induces convulsions only when given in much larger 
amount than is ordinarily required for this purpose. As re- 
gards the motor areas of the cerebral cortex, it is found that a 
stimulation of the areas which, under the conditions of the 
experiment ordinarily give rise to general epileptiform convul- 
sions, will, after the administration of bromide, be confined to 
the area directly stimulated. It would appear, therefore, that 
the whole cerebrum, as well as the spinal cord, is powerfully 
depressed by the bromides. In man, at least, the depression, 
beginning with the higher functions of the brain, takes place 
in regular order from above downwards, in the reverse order 
of the physiological development of the functions; the action, 
as in the case of many other drugs, following out the Law of 
Dissolution (see p. 737). 



BROMINE. 795 

Circulation. — Large doses of potassium bromide have a de- 
pressant action on the heart, an effect which is due to the potas- 
sium ion. If the amount is sufficiently great, diastolic arrest 
may be caused in animals. Sodium bromide has little or no 
depressing influence, while the ammonium salt is slightly stimu- 
lating to the heart. After the bromides there is often found a 
contraction of the blood-vessels of the pia mater, and this con- 
dition has been supposed to produce cardiac depression, but it 
seems probable that this anaemia of the brain is analogous to 
that observed in sleep, and is a result, rather than the cause, 
of the depression. 

Respiration. — The respiration is more or less depressed by 
large doses. Under toxic amounts the breathing grows pro- 
gressively slower and shallower, probably from depression of 
the respiratory centre. Asphyxia is the usual cause of death 
in animals, although if the potassium salt is employed in any 
large amount, fatal cardiac paralysis may be induced by the 
poisonous action of the potassium on the heart muscle. After 
a small toxic dose the frog's heart has been observed to con- 
tinue beating long after the failure of the respiration. 

Temperature. — In animals toxic doses not infrequently pro- 
duce some fall of temperature, and this is regarded as being 
due to the lessened movement. 

Sexual Organs. — Bromides have a distinct anaphrodisiac 
influence. Whether the depression of the sexual instinct 
which has been mentioned is due to the action on the cerebral 
cortex or on the spinal cord has not been determined. A fail- 
ure of sexual vigor almost invariably results from the long- 
continued administration of the bromides. 

Metabolism. — Under large doses there is a marked diminu- 
tion in the amount of carbon dioxide exhaled. The quantity 
of urine is increased, particularly after the use of the lithium 
salt. The nitrogenous metabolism is not apparently affected, 
but the sulphur in the urine is increased, while quite commonly 
the phosphates are materially reduced. 

Excretion. — The bromides, which are rapidly absorbed by 



yg6 PHARMACOLOGY AND THERAPEUTICS. 

the mucous membranes, are eliminated mainly by the kidneys, 
but to a small extent also in the perspiration and milk. There 
is probably some excretion likewise by the bronchial and intes- 
tinal mucous membrane. The disagreeable odor sometimes 
noticed in the breath in chronic poisoning has been supposed 
to be due to the elimination by the lungs of bromine or some 
of its volatile organic compounds. The hydrobromic acid 
secreted into the stomach in bromism is thought to be all reab- 
sorbed in the intestines. Some of the bromide is rapidly elim- 
inated, as it can be detected in the urine a few minutes after 
injection, but the great mass of the drug is found to be excreted 
only very slowly. Therefore, under its continued administra- 
tion there is an accumulation in the system, though it has been 
shown that the proportion excreted increases with the increase 
of the salt in the blood until an equilibrium is established, 
exactly as much bromine appearing in the urine as is absorbed 
from the stomach. After the discontinuation of the drug the 
excretion still goes on, and it has been detected in the urine for 
as long as sixty-five days later. The slow excretion of bro- 
mides is regarded as affording support to the theory that the 
bromine enters into combinations in the body, and it is thought 
probable that it may to some extent take the place of chlorine 
in the combinations of the latter, especially as the excretion of 
chloride is increased. The administration of sodium chloride, 
it is said, accelerates the excretion of the bromine, and ameli- 
orates the symptoms of bromism. 

Comparative Action of the Bromides. — Certain of the differ- 
ences between the various salts have already been incidentally 
referred to, but a little further attention may be given to the 
subject. None of the bromides has any action on nerve and 
muscle unless applied directly to the excised structures. The 
effects of potassium and sodium salts differ chiefly in the ab- 
sence of any changes in the heart or in the muscles when ex- 
posed to the solution of sodium bromide. Potassium bromide 
is also more depressant to the central nervous system on ac- 
count of the influence of the potassium ion. Under large doses 



BROMINE. 797 

of ammonium bromide the convulsive action characteristic of 
ammonium has been observed in animals. The depressant 
action of lithium bromide is probably next to that of the potas- 
sium salt, and it is said by some even to exceed the latter in 
this respect. It is the richest in bromine, containing 92 per 
cent., and though it has not been so largely used as the others, 
is thought to have the most pronounced hypnotic influence of 
any. It is asserted that the strontium and calcium salts cause 
less disturbance of the .digestion than the others, but they are 
apt to be absorbed more slowly by the intestine than those of 
the alkalies. Zinc bromide, if the dose is sufficiently large, may 
act as an irritant poison. 

Bromism. — The name bromism has been given to chronic 
poisoning by the bromides. It is to be noted that hydrobromic 
acid (see p. 801), although containing a larger proportion of 
bromine, rarely gives rise to this condition. Usually the first 
symptom is an eruption of papular acne, which appears chiefly 
upon the face and back. In severe cases the papules pustulate 
and then the pustules may coalesce, forming small abscesses 
and eventually ulcers. In other instances the rash produced 
resembles eczema, and in still others there is erythema or a 
brown discoloration of the skin. A coated tongue and disor- 
dered digestion are constant symptoms. There is not infre- 
quently some coryza, with or without an increased secretion 
from the bronchial mucous membrane, and sometimes a 
mild conjunctivitis. These various effects are regarded as due 
to a local irritant action, due in part to the salt action of the 
bromide salt and in part to the decomposition of the bromide, 
with liberation of bromic acid and bromine, by the free acids 
in different situations: as hydrochloric acid in the stomach, 
carbon dioxide in the air passages, and the acid secretions of 
the sebaceous glands in the skin. This action is said to be 
favored by insufficiency of the kidney and to be more readily 
induced in old age. From the influence of the drug on the 
nervous system the general cutaneous sensibility and the sen- 
sitiveness of the faucial mucous membrane are distinctly re- 



798 PHARMACOLOGY AND THERAPEUTICS. 

duced, while the sexual appetite also becomes markedly dimin- 
ished. The patient is indisposed to make any exertion and is 
easily fatigued, while his gait is uncertain and every movement 
may be attended by tremor. The mental phenomena observed 
are of the nature of continuations and exaggerations of the 
effects of a single dose. The intellect is dulled and the memory 
especially is affected. The patient takes little or no notice of 
what is going on around him, he speaks slowly and stammers, 
and is apt to mispronounce ordinary words or miss several 
words out of a sentence. The mental condition induces a stu- 
pid and apathetic expression of countenance, while the eyes 
become heavy and lustreless. Occasionally maniacal excite- 
ment, mental confusion, and even delirium are observed after 
continued use of moderate doses, particularly of the potassium 
salt. Those who take bromides habitually generally find them- 
selves unable to sleep without them, and as a gradual increase 
of the dose is required to produce sleep, the effects on the sys- 
tem are usually disastrous. In addition to suffering from the 
special evils of bromism, the patient, on account of his lowered 
resistance, is rendered more liable to contract disease of any 
kind, and not infrequently the immediate cause of death is an 
attack of pneumonia or bronchitis. Notwithstanding the grav- 
ity of the symptoms in bromism, after the withdrawal of the 
drug they generally disappear soon after there no longer re- 
mains any bromine in the system. 

Therapeutics of the Bromides. 
External. — Before the days of local anaesthetics it was cus- 
tomary to paint the pharynx with a bromide solution in order 
to diminish the sensibility of the throat before making a laryn- 
geal examination. Finely powdered potassium bromide is 
stimulant to chronic ulcers, and is said to be advantageous in 
epithelioma. With 5 parts of glycerin, it has been used as a 
soothing application for painful haemorrhoids and fissures of the 
anus, and in solution (.60 to 1.20 gm. ; 10 to 20 gr. to 30 c.c. ; 
1 fl. oz. of water) for the relief of paraesthesia. 



BROMINE. 799 

Internal. — As would be inferred from their physiological 
action, the bromides are of great service in various nervous dis- 
eases for the relief of which a depressant effect is required. 
They are the most valuable remedies at our command in the 
treatment of epilepsy, their good effects being probably due to 
their influence in reducing the excitability of the cortical motor 
areas. When pushed in a suitable manner, they sometimes 
prove curative, and though this happy result is by no means 
always to be looked for, they are in most instances of great 
service in diminishing both the frequency and severity of the 
attacks. Consequently, they may be said to be indicated in 
every case of the disease, and their use should be abandoned 
only after a thorough trial has demonstrated their inefficiency. 
As a rule, they are more successful in cases of grand mal than 
of petit mal, and in cases in which the seizures occur in the 
daytime rather than in those where they are exclusively noc- 
turnal. Experience seems to show that rubidium and ammo- 
nium bromide (in doses of 2 gm. ; 30 gr.) is the most serviceable 
in some instances, but the potassium salt is the one in most 
general use and considered the most efficient by many. There 
are special circumstances, however, in which some one of . the 
various other bromides possesses certain advantages and may 
succeed when the potassium salt has failed. Sometimes the 
combination of the three bromides, potassium, sodium and am- 
monium, acts better than any one of the salts alone. Bella- 
donna often increases the efficiency of bromides in petit mal. 
As the bromides when applicable in epilepsy must be admin- 
istered for an indefinite period, every effort should be made to 
minimize their objectionable effects upon the system. Thus, it 
is often advisable to intermit the remedy from time to time, or 
to change from one bromide to another. To counteract the 
depression, the bromide is sometimes given in infusion of ca- 
lumba or digitalis, or strychnine is given hypodermatically at 
the same time. It has been claimed by some that most of the 
ill effects of the bromides may be avoided by giving them in 
combination with intestinal antiseptics, such as sodium sali- 



800 PHARMACOLOGY AND THERAPEUTICS. 

cylate and naphthol; while others have observed that taking 
strong coffee with the meals hinders the development of bro- 
mism. For the prevention or amelioration of acne, arsenic is 
the best remedy. When the convulsive attacks have ceased to 
make their appearance, it is advised that a single dose of 4 gm. 
(1 dr.) of bromide should be taken daily at bedtime for a year, 
and after that on alternate nights for at least a year longer. 
It is better that the remedy should not be discontinued alto- 
gether for fully three years. As hypnotics and for quieting 
nervousness and hysteria the bromides are often extremely use- 
ful, but their too long continued employment should be avoided 
on account of the risk of the patient's becoming an habitue of 
the drug. They are especially useful in the wakefulness of 
fatigue, worry and cerebral over-work. In various forms of 
convulsions both in adults and children they are efficient, par- 
ticularly when combined with hydrated chloral. This combina- 
tion may be useful also in delirium tremens. Here the dose of 
bromide should be very large, often as much as 4 gm. (1 dr.), 
and it is of more service in the preliminary stage of wakeful- 
ness and excitement than after the delirium is fully developed. 
Other affections in which bromides may be employed are laryn- 
gismus stridulus, the night-screaming of children, migraine, 
neuralgia, dysmenorrhea and menorrhagia, particularly in 
young subjects, seminal emissions, satyriasis and nymphomania. 
In migraine and neuralgia the combination with caffeine is 
often very efficient. The bromides have been considerably used 
in the treatment of whooping-cough, but cannot be said to have 
proved of much value. They are of service in the laryngeal 
crises of locomotor ataxia and, in full doses, in acute laryn- 
gitis. In cases where irritability of the pharynx and larynx 
interfere with a satisfactory examination of these parts, the 
trouble may be obviated by the administration of one or two 
full doses. They are the best prophylactics which have as yet 
been discovered for seasickness, and should usually be em- 
ployed in doses of about .60 gm. (10 gr.) three times a day for 
a number of days before sailing, though a larger amount will 



BROMINE. 8oi 

sometimes be required. After seasickness has commenced, 
they should be given in small doses, frequently repeated, in an 
effervescing draught made by mixing a solution of citric acid 
with one containing the bromide and potassium bicarbonate. 
They may also be used in the same way in the vomiting of 
pregnancy, the vomiting following etherization, and other per- 
sistent forms of vomiting which are not due to primary gastric 
disturbance. In cases where this method proves inefficient, the 
bromide may be given with the tincture of deodorized opium in 
a small enema of starch water. The bromides have also been 
employed to prevent the nausea and depression resulting from 
opium, as well as for the symptoms of cinchonism and salicyl- 
ism. They are of service in the abdominal neuroses, such as 
cholera infantum when it is due, not to defective alimentation 
or other local trouble in the gastro-intestinal tract, but to an 
irritable state of the nervous system. In some varieties of 
functional disease of the heart they are of decided benefit. 
Lithium bromide has been prescribed in various gouty and rheu- 
matic conditions, and potassium bromide is recommended as an 
eliminating agent, combined with potassium iodide, in mercurial, 
copper and lead poisoning. In a considerable number of cases 
potassium bromide has proved successful in the treatment of 
tetanus. Not less than 15 gm. ( J / 2 oz.) should be given in the 
day, and hydrated chloral should be used as an hypnotic at 
night. This bromide, in full doses, is also of value as an anti- 
dote for strychnine poisoning. 

ACIDUM HYDROBROMICUM DILUTUM.— Diluted Hydrobromic 
Acid. Dose, 4 c.c; 1 fl. dr. 

Action of Hydrobromic Acid. 
Hydrobromic acid appears to have the characteristic bromide 
action after absorption, but it also has the local action of an 
acid; which makes it more irritant than the bromides. While 
pleasanter to take than the latter, it is, therefore, more apt to 
create gastric disturbance. 
52 



802 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Hydrobromic Acid. 
It was introduced as a substitute for the bromides, but it 
failed to fulfill the expectations of its usefulness, and is now 
very rarely employed for the same purposes. It has some re- 
pute in preventing the untoward symptoms of quinine, of which 
drug it is an excellent solvent. Thus, it is said to give prompt 
relief in the annoying tinnitus aurium occasioned by it, though 
it often fails in relieving tinnitus from other causes. It has 
been highly recommended for headaches due to eye-strain, espe- 
cially in nervous women. 

F. Drugs Acting on the Brain, 
i. General cerebral stimulants. 

BELLADONNA. 
BELLADONNA FOLIA.— Belladonna Leaves. (Deadly Night- 
shade.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 
i. Extractum Belladonnae Foliorum (Extractum Belladonna 
Foliorum Alcoholicum, U. S. P., 1890). — Extract of Belladonna 
Leaves. Dose, 0.010 gm. (10 milligm.); y 6 gr. 

2. Pilulae Podophylli, Belladonnae et Capsici. — Pills of Podo- 
phyllum, Belladonna and Capsicum. Dose, 1 pill. 

3. Pilulae Laxativae Compositae. — Compound Laxative Pills. 
Dose, 2 pills. 

4. Tinctura Belladonnae Foliorum. — Tincture of Belladonna 
Leaves. Dose, 0.5 C.C.; 8 TT\,. 

5. Unguentum Belladonnae. — Belladonna Ointment. 

6. Emplastrum Belladonnae. — Belladonna Plaster. 

BELLADONNA RADIX.— Belladonna Root. Dose, 0.045 gm. (45 
milligm.); % gr. 

Preparations. 
1. Fluidextractum Belladonnae Radicis. — Fluidextract of 
Belladonna Root. Dose, 0.05 C.C.; 1 Til. 
2. Linimentum Belladonnae. — Belladonna Liniment. 



BELLADONNA. 803 

ATROPINA.— Atropine. Dose, 0.0004 gm. (0.4 milligm.) ; y i ¥ gr. 

Preparation. 

Oleatum Atropinae. — Oleate of Atropine. 

ATROPINE SULPHAS.— Atropine Sulphate. Dose, 0.0004 gm. 
(0.4 milligm.) ; T ^ gr. 

Unofficial Preparation. 

Atropinae Santonas. — Atropine Santonate. Dose, 0.06 (1 ni ) 
of a solution of 0.01 gm. (y 6 gr.) in 20 gm. (300 gr.) of water is 
sufficient to dilate the pupil. 

Action of Belladonna. 

The action of belladonna is due to the atropine in it. 

External. — Atropine by itself is not absorbed by the unbroken 
skin, but when rubbed in with absorbable substances, such as 
alcohol, glycerin, camphor, animal fats, etc., or when applied to 
abraded surfaces or mucous membranes, it has a well-marked 
local action and is also capable of producing systemic effects. 
Its chief local effect is a paralyzation of the sensory nerve ter- 
minations, so that it acts as an anaesthetic and anodyne, and 
it also depresses the motor nerve terminations, though less 
markedly, and tends to inhibit secretion. On the peripheral 
vessels it has first a constricting and then a dilating influence. 
Applied to the conjunctiva, it is a typical mydriatic. 

Internal. Blood. — Atropine is rapidly absorbed into the 
blood, and it is stated to diminish the number of leucocytes. 

Nervous System. — The main action of atropine is on the 
nervous system, and most of its effects in the organism are due 
to its influence upon the various portions of this. The action 
extends from the hemispheres downward, and in the medulla 
oblongata the drug first stimulates and then depresses the three 
principal centres. Its dominant and characteristic action is a 
depression of the terminations of most varieties of nerves. 

Secretory Nerves. — On the activity of the peripheral termina- 
tions of all the secretory nerves in the body, it has, so far as 



804 PHARMACOLOGY AND THERAPEUTICS. 

known, a distinctly depressant effect. The secretions are not, 
however, all affected to the same extent, since with some of 
them the nervous influence is not so important as in the case 
of others. The secretion of saliva is entirely dependent upon 
the integrity of the nervous connection, and hence may be 
entirely arrested by atropine. Thus, in an animal under the 
influence of the drug, stimulation of the chorda tympani, which 
is the secretory nerve of the submaxillary gland, no longer 
causes an increased flow of saliva, as is the case under ordi- 
nary circumstances, and it has been shown by experiments ex- 
cluding the participation of the ganglia and gland cells that the 
action is on the nerve endings. Furthermore, it has been shown 
that no paralysis results of the vaso-dilator fibres which move 
along with the secretory fibres of the chorda tympani, the secre- 
tory fibres alone being selected by the atropine for its attack. 
In the same way the secretory nerve terminations in the other 
salivary glands and the buccal mucous glands are paralyzed, 
and as the normal impulses are thus prevented from reaching 
the gland cells, the mouth becomes dry. Even small doses of 
atropine will cause a considerable amount of dryness. From 
the same cause the secretion of the glands of the throat, nose 
and respiratory passages is stopped, and as a result there are 
produced hoarseness of the voice, thirst and difficulty of swal- 
lowing. The skin likewise becomes dry from the paralysis of 
the terminations of the nerves in the sudoriparous glands. 
While atropine diminishes the secretion of milk by the same 
process, it does not check its flow entirely, as the mammary 
gland has been found to continue to secrete after all its nerves 
have been severed. The solids of the milk are thought to be 
augmented rather than diminished. Recent investigations have 
shown that by its action in paralyzing the terminations of the 
secretory fibres of the pneumogastric nerve in the stomach,, 
atropine diminishes or may even entirely arrest the secretion 
of gastric juice. The pancreatic secretion, although it is not 
entirely dependent on nervous impulses, is similarly affected; 
so that after atropine the increased secretion which ordinarily 



BELLADONNA. 805 

occurs upon the entrance of food or of acid into the intestine 
does not take place, while stimulation of the pneumogastric, 
which ordinarily increases it, has no effect. The bile is also 
said to be diminished, and it would seem probable that the in- 
testinal secretions are affected likewise. Some diminution in 
the urine, as well as an alteration in the proportion between 
its nitrogenous constituents, has been observed after atropine, 
but it is unknown how far such results may be due to its action 
on the kidney and how far to its effect on other organs. The 
amount of the urinary flow, as is well known, is largely de- 
pendent on the secretion of sweat. The flow of lymph is not 
affected by atropine, and from this fact it is inferred that this 
is not controlled by nerves in the same way as the true secre- 
tions. 

Sensory Nerves. — The effect of atropine when locally applied 
in paralyzing the terminations of the sensory nerves has already 
been mentioned. The same local anodyne action is not ob- 
served from its internal administration, although some recent 
investigators have claimed that the sensory terminations are 
first stimulated and then paralyzed by the drug. It is said, 
however, that the frog may be rendered less sensitive to cuta- 
neous irritation if poisoned with atropine. 

Involuntary Muscles and their Nerves. — The innervation of 
all unstriped muscle seems to be depressed or paralyzed by 
atropine. Hence the movements of the stomach, intestine, 
bladder, uterus, spleen, bronchial muscle, thoracic duct, and of 
the pupil and oesophagus (except in animals in which these 
consist of striped muscle) are more or less diminished by it. 
In the intestine not only is normal peristalsis lessened, but that 
which is caused by direct nerve stimulation, as by electricity 
or drugs such as muscarine and pilocarpine's promptly arrested 
by atropine. Immediately after the injection of the atropine 
there usually occurs an increase in the intestinal movements. 
This might be cited as proof that it causes a preliminary stimu- 
lation of the nerve terminations, but may also be explained by 
the inhibitory endings being paralyzed earlier than the motor. 



806 PHARMACOLOGY AND THERAPEUTICS. 

Ordinarily the movements, although they become diminished, 
are not finally arrested, since the intestinal muscle, like the other 
involuntary muscles, is capable of maintaining a regular move- 
ment independently of nervous impulses from without. It is 
thus found that any irritating substance will cause peristalsis 
after atropine, and that the action of purgative drugs is not in- 
terfered with by it. It is a common practice to give belladonna 
in association with purgatives for the purpose of preventing 
griping, and the generally accepted explanation of this result is 
that the local contractions of the intestinal wall which are sup- 
posed to give rise to the griping are due to nervous influence, 
and hence disappear under the action of the drug. Very large 
quantities of atropine are said to paralyze the muscle of the in- 
testinal wall, but this, it has been pointed out, could scarcely 
occur except under special conditions, as paralysis of the res- 
piratory centre would undoubtedly -precede it. 

Voluntary Muscles and their Nerves. — Atropine has no direct 
action on the voluntary muscles. In the frog the terminations 
of the motor nerves are paralyzed by very large amounts, but it 
is said that this result has not been elicited in mammals by 
ordinary methods of experimental investigation. 

The Eye and its Nerves. — Whether atropine be dropped into 
the eye or given by the mouth, it has the effect of widely dilat- 
ing the pupil. This is due to paralysis of the terminations of 
the motor oculi nerve in the sphincter muscle. It is found that 
the paralysis is limited to the periphery, and that the muscle 
is not acted on is shown by the fact that it reacts to electrical 
stimulation. The pupil dilates because the elastic fibres of the 
iris have an opportunity to act. That the action is local is 
shown by its remaining confined to the eye, and even to that 
side of the eye to which atropine is directly applied, and also 
by the fact that it can be produced on the excised eye of a frog 
and even on the isolated iris. There is also a loss in the power 
of accommodation, and this is caused by paralysis of the motor 
oculi terminations in the ciliary muscle. In consequence of it, 
near objects are no longer seen clearly. In addition, there is 



BELLADONNA. 807 

increase of intra-ocular tension, such as usually accompanies 
dilatation of the pupil, and this is supposed to be probably due 
to the dilatation. The dilatation is found to be not quite maxi- 
mal, since it is generally increased, though but slightly, by 
stimulation of the cervical sympathetic trunk. In birds and 
reptiles atropine has no action on the iris, which in them con- 
tains striped instead of unstriped muscle. 

The Heart and its Nerves. — The inhibitory terminations of 
the vagus in the heart are paralyzed by atropine. Consequently 
the heart-beat is accelerated, and stimulation of the vagus does 
not produce any change in it. In man the amount of accelera- 
tion produced varies considerably with the age of the subject, 
the vagus being most active in middle life. In the new-born 
infant there is no quickening of the heart, but up to about 30 
the acceleration increases with the age, and from this point on 
lessens again. In its main action on the heart atropine is there- 
fore directly antagonistic to muscarine, which has the effect of 
stimulating the cardiac terminal filaments of the vagus. A 
second effect on the heart is often said to be a slight stimula- 
tion of the cardiac muscle by small doses, but there is reason 
to believe that the drug really has no such action. Large 
amounts undoubtedly weaken and depress the muscle, and may 
cause arrest in diastole. Furthermore, atropine has some stimu- 
lating influence on the cardiac centres in the medulla oblongata. 
This action, however, is for the most part overshadowed by 
the peripheral effects, though it may induce a preliminary slow- 
ing of the pulse. The circulation always persists after the 
cessation of respiration, and its failure is therefore not the 
cause of death in atropine poisoning. 

Vaso-motor System and its Nerves. — Atropine causes a con- 
siderable rise in blood-pressure, an effect which is due in part 
to the acceleration of the heart-beat, and largely also to stimu- 
lation of the vaso-constrictor centre in the medulla oblongata, 
since it is much less marked after division of the spinal cord. 
This central stimulation has the effect of causing a contraction 
of the abdominal arterioles, which is accompanied by a dila- 



808 PHARMACOLOGY AND THERAPEUTICS. 

tion of the arterioles of the skin and probably also, it is thought, 
of the brain, from excitation of the vaso-dilator centre. Hence 
there results a movement of blood from the abdomen towards 
the periphery; but as the dilation of the cutaneous vessels can- 
not altogether counteract the constriction of the abdominal 
ones, a rise in blood-pressure is induced. The dilatation of the 
surface vessels is most marked in the region of the head and 
neck, where it causes a pronounced flushing of the skin. In 
many instances there is observed a rash like that of scarlet 
fever, and the hyperemia may be so intense as to lead to des- 
quamation. That it is due to central action is shown by the 
fact that it is prevented by section of the cervical sympathetic 
trunk. The increased arterial tension is maintained for some 
time after small doses, but large amounts soon bring about a 
fall in the blood-pressure by this action on the muscle fibre of 
the heart. Under toxic doses the pressure falls very low from 
paralysis of the vaso-motor centre and arterial muscles, as 
well as of the cardiac muscle. The spinal vaso-motor centres 
are acted on in the same way as the medullary. 

Respiration and its Nerves. — The respiration is often slow 
at first, not, as was formerly supposed, from paralysis of the 
sensory peripheral filaments of the vagus in the lungs, but from 
some central action the precise nature of which has not as yet 
been explained. Soon, however, in consequence of stimulation 
of the respiratory centre in the medulla, the breathing becomes 
quicker and also probably deeper, and the amount of air in- 
spired per minute is found to be considerably increased. Under 
large amounts of atropine the centre is rapidly depressed. The 
respiration grows shallower and slower, and in fatal cases 
death results from failure of this function. Not infrequently 
the breathing is interrupted by convulsive movements, and in 
many instances is then never resumed. Both the afferent and 
efferent terminations of the vagus in the lungs are paralyzed 
by atropine, and not only is the bronchial muscle relaxed, but 
the secretions, which are diminished in quantity, are now less 



BELLADONNA. 809 

irritating in consequence of the depression of the afferent fila- 
ments. In this way the drug has the effect of lessening cough. 

Central Nervous System. — The action on the central nervous 
system consists of a true stimulation, followed by depression, 
and if the amount is sufficient, paralysis. While caffeine affects 
chiefly the higher divisions of the central axis, and strychnine 
the lower, the seat of the influence of atropine may be said in 
a general way to be intermediate as regards these. In the case 
of caffeine the highest functions of the cerebrum, the psychical, 
are involved first of all, but atropine acts principally on the 
motor divisions of the brain. It is likely to cause restlessness, 
vertigo, garrulity, incoherence of speech, staggering gait, chore- 
oid movements, uncontrollable laughter or weeping, a busy 
delirium, and mania. In the subsequent paralytic stage, drow- 
siness, coma, and finally convulsions may occur, the latter 
largely from asphyxia. In the poisoning the medulla and spinal 
cord are involved, but in the cord the action is very much 
weaker than that of strychnine and appears much later. In the 
frog much the same effects are found to be produced by atro- 
pine as by the latter drug, because, the higher parts of the 
central nervous system being less developed than in mammals, 
the first symptoms observed are those arising from the cord. 
Young animals can bear much larger quantities of atropine or 
belladonna than older ones, and it has been suggested that the 
explanation of this is because the brain is less highly developed 
and the cerebral symptoms are therefore elicited less easily. It 
is also a fact that in the human subject children are much less 
susceptible to the influence of the drug than adults. 

Temperature. — Atropine often causes a rise of temperature, 
which may amount to 2° C. (4 F.) or more. This has been 
attributed to a direct action on the cerebral heat centres, though 
it cannot be said that proof of such action is positively estab- 
lished, and seems to be independent of the blood-pressure and 
the diminished respiration, as well as of the convulsions. While 
the dissipation of heat is increased, probably because the flush- 



8lO PHARMACOLOGY AND THERAPEUTICS. 

ing of the skin leads to a greater loss by radiation, the heat 
production is apparently increased to a still greater extent. 

Elimination. — Atropine is excreted principally by the kidneys, 
but also passes into the milk and into the fcetal circulation. In 
herbivorous animals particularly it is excreted very rapidly in 
the urine. They exhibit a much greater tolerance of the drug 
than the carnivora or man, and this probably accounts largely 
for the difference. Rabbits, it is found, may be fed for weeks 
exclusively on belladonna leaves without presenting any symp- 
toms of poisoning. Pigeons are also very insusceptible to the 
action of the drug. The uric acid of the urine is said to be 
diminished by it. 

Therapeutics of Belladonna. 
Externally. — Belladonna, and sometimes atropine, is used 
locally to relieve pain of all kinds, to check sweating and the 
secretion of milk, and to relax spasm, while atropine is em- 
ployed to a considerable extent in ophthalmological practice. 
For neuralgia, myalgia, lumbago, acute inflammations, and 
chronic rheumatism and other painful affections of the joints 
belladonna is often applied in the form of liniment, ointment 
or plaster. It is also used in a great variety of combinations. 
A very good one is Chloroformum Belladonnas (Brit. Pharm. 
Conference), in which the root is extracted with ammonia and 
chloroform, and it should be diluted with a little olive oil. An- 
other is a preparation made by rubbing the extract of bella- 
donna leaves, 4, with boiling water, 1, and then gradually 
adding glycerin, 12. For severe local pain atropine is some- 
times combined with aconitine or other alkaloids. To re- 
lieve the pain of herpes zoster, and of irritable or malignant 
ulcers, cocaine hydrochloride, .30 gm. (5 gr.) with belladonna 
ointment, 30 gm. (1 oz.), may be of service. Belladonna is also 
useful in painful haemorrhoids and fissure of the anus, to check 
the suppurative process in furuncle, abscess and carbuncle, and 
to promote the resolution of enlarged glands. The plaster is 
an excellent application to relieve the chest-pains of phthisis 



BELLADONNA. 511 

or to allay irritability of an over-excited heart. For inter- 
costal neuralgia or pleurodynia, strapping the chest with bella- 
donna plaster is usually the most efficient way of applying the 
drug. In the form of the plaster or ointment it is much used 
as an antigalactagogue. A more elegant method is to envelop 
the breast in lint wet with a solution of atropine in rose-water, 
.24 gm. (4 gr.) to 30 c.c. (1 fl. oz.). The liniment, applied 
several times a day, is of great service in restraining excessive 
local sweating, and a lotion or ointment containing belladonna 
may be successfully employed in pruritus, urticaria and chronic 
eczema attended with much itching. In rigidity of the cervix 
uteri in the first stage of labor an old practice is to smear the 
os with extract of belladonna, but it is of very doubtful utility. 
A suppository containing the extract, alone or in association 
with opium, has been recommended in dysmenorrhea dependent 
upon spasm of the cervix. It has been asserted that oleate of 
atropine makes a suppository of much more uniform composi- 
tion than when -extract of belladonna is employed. A solution 
of atropine in chloroform or in equal parts of chloroform and 
alcohol (.30 gm. ; 5 gr. of the alkaloid to 30 gm. ; 1 oz. of men- 
struum), applied to the epigastrium on a piece of lint, will some- 
times relieve obstinate vomiting, cerebral or reflex, such as that 
of pregnancy, seasickness, etc. In ophthalmological practice 
atropine is used to dilate the pupil and relax the accommoda- 
tion in order to facilitate examination of the eye and determine 
its refraction, and also to destroy adhesions and to prevent con- 
traction of the iris or its protrusion through an ulcer of the cor- 
nea. The solutions of atropine for such purposes, as well as for 
hypodermatic injection, should be freshly prepared and steril- 
ized each time, in order to avoid the development of penicillium 
in the liquid. Atropine sulphate is the salt commonly selected 
for dilating the pupil, and some such solution as the following 
may be employed : Atropine sulphate, 4 ; boric acid, 5 ; in water to 
480. Some oculists prefer atropine santonate, and some advo- 
cate the use of atropine sulphate and duboisine sulphate, with 
cocaine hydrobromide ; claiming that by this combination of al- 



8l2 PHARMACOLOGY AND THERAPEUTICS. 

kaloids the same effects may be obtained with smaller doses. 
Atropine must not be used if the patient is suffering from glau- 
coma. In certain individuals even perfectly neutral solutions 
are very irritant, giving rise to what is known as atropine 
conjunctivitis, and the alkaloid also acts as an irritant in some 
cases of iritis, particularly those occurring in rheumatic pa- 
tients with posterior adhesions. When belladonna is applied 
in the ointment or other form to open surfaces, the pupils and 
throat of the patient should always be carefully watched. 
Atropine sulphate is employed locally to a limited extent in 
diseases of the ear. 

Internal. — Belladonna or atropine is given to check saliva- 
tion from the use of mercury or other drugs and the excessive 
ptyalism sometimes met with in children and pregnant women. 
It is one of the best remedies known for the night-sweats of 
phthisis, and for checking this and other objectionable forms 
of sweating atropine sulphate (.006 gm. ; T fa gr.) may be in- 
jected hypodermatically, or .06 to .12 c.c. (1 or 2 "ni) of a solu- 
tion of atropine sulphate in camphor water (1 to 100) given 
by the mouth. For bromidrosis of the feet and other localized 
sweatings also the drug may be used internally, as well as exter- 
nally. It has been employed in serous diarrhoea on the ground 
that it tends to check this by stimulating the splanchnic vaso- 
motor filaments of the intestinal blood-vessels, the inactivity of 
which permits a transudation of liquid into the bowel. It is 
also given to overcome constipation and colic, and the ex- 
tract of belladonna leaves is a frequent constituent of purga- 
tive pills. In appendicitis or peritonitis this extract is some- 
times administered in frequently repeated doses in a pill with 
opium, for the purpose of paralyzing intestinal movements and 
thus assisting the action of the latter drug. In intestinal ob- 
struction the propriety of administering atropine has given rise 
to much discussion. It is only in the paralytic or spastic forms 
that internal treatment would seem to be useful, and in the for- 
mer small doses of atropine and in the latter large ones may 
be of service. In gastralgia, as well as the pain accompanying 



BELLADONNA. 8 I 3 

gastric ulcer, and in pyrosis, chronic gastric catarrh, and irri- 
tative dyspepsia, atropine often affords marked relief, and in 
cases of this kind it may usually be combined advantageously 
with small doses of zinc sulphate. Administered with dilute 
hydrochloric acid, it is useful in heart-burn, water-brash, etc. 
It may also be of service in the vomiting of pregnancy and 
other reflex varieties of vomiting when given by the mouth, as 
well as when applied to the epigastrium. Sometimes it seems 
to be more efficient if used in suppository. Sick-headache due 
to or accompanied by spasm of the arterioles (as indicated by 
pallor of the face, vertigo and tinnitus anrium), is frequently 
relieved by belladonna. It is also of service in the headache 
of young persons, often due to over-work, in which there is 
pain in the eyeballs and forehead, with a sensation commonly 
described as a feeling that the orbits are too small for the eye- 
balls. This drug is a valuable remedy in many cardiac affec- 
tions. Thus, as it accelerates the heart's pulsations without 
diminishing their force, it may be employed whenever it is 
desired to completely empty the ventricles. Its greatest service, 
however, is in relieving cardiac pain and distress. Here it may 
be applied over the precordial region, as mentioned, or given 
internally, usually as the tincture of the leaves. It is also use- 
ful in the treatment- of shock and collapse from injury or in 
the course of disease, and in pneumonia particularly it should be 
resorted to when after the crisis there is great relaxation of the 
vascular system and heart stimulants are found to be ineffective. 
Here the administration of atropine or belladonna will dry a 
moist skin and by increasing the vaso-motor tone often pro- 
duce marked improvement. In caseous pneumonia the drug, it 
is claimed, has a distinctly curative effect. Given in full dose, 
it will not infrequently abort colds in which the pharynx is hot 
and dry and has a feeling of rawness, while the local capillaries 
appear injected and red. It is also of much benefit in acute 
coryza. In whooping-cough (where it should be given freely) 
and other spasmodic affections of the respiratory passages it 
has long been esteemed one of the most reliable remedies. For 



8 14 PHARMACOLOGY AND THERAPEUTICS. 

the symptom asthma it is of most service when combined with 
opium, and it may be given both during the attacks and as a 
prophylactic in the interval. Belladonna leaves rolled into 
cigarettes or put into a pipe are often smoked by asthmatics, 
but the most effective way of administering the drug here is 
the hypodermatic injection of atropine. In bronchitis with a 
tendency to paroxysmal spasm the tincture of the leaves is 
frequently associated with other remedies. The following is 
a very satisfactory mixture : Tincture of belladonna leaves, 3 ; 
vinegar of squill, 5 ; syrup of tolu, 10; glycerin, to 60 parts. For 
the nervous cough of both children and adults belladonna is an 
excellent remedy. It is also useful in laryngismus stridulus 
and in hiccough. Atropine has been used with good effect in 
the aphonia caused by fatigue of the vocal cords and likewise 
in hysterical aphonia. The utility of belladonna, when applied 
to the breasts, for " drying up " the milk has already been men- 
tioned. It is also of great service, employed both locally and 
internally, in cases of mastitis, and even when the formation 
of pus has already commenced it will often check the inflam- 
matory process if used in sufficient amount. Belladonna is 
probably the most efficient remedy we have for the nocturnal 
enuresis of children, and is also valuable in urinary inconti- 
nence in adults when this depends upon vesical spasm. It re- 
lieves enuresis because it has an anodyne effect upon the cen- 
tres in the cord, and, when excreted in the urine, anaesthetizes 
the neck of the bladder. It is also sometimes useful in the 
treatment of nocturnal seminal emissions. Its property of re- 
laxing the spasm of involuntary muscle is well shown in the 
relief which it affords in the acutely painful vesical spasm which 
accompanies urinary calculus, cystitis and prostatitis. Here it 
may be employed in the form of a suppository or applied to the 
perineum in ointment or plaster, or it may be used both inter- 
nally and externally. In urethral spasm and in chordee it may 
be given internally, and the ointment may be smeared along the 
under surface of the penis. By its action in relaxing spasm 
belladonna will also often give relief in the colic resulting from 



BELLADONNA. 8 I 5 

the passage of hepatic and renal calculi. On account of the 
similarity of the symptoms of atropinism with those of scarlet 
fever, belladonna has been vaunted as a prophylactic against 
this disease, but abundant experience has shown that the drug 
is absolutely valueless in this regard. It may, however, prove 
useful in relieving some of the symptoms of scarlatina, and is 
thought to be indicated when during the stage of eruption the 
pulse is feeble, the system much depressed, and the rash im- 
perfectly developed. As ammonium carbonate is often pre- 
scribed in this condition of affairs, it must not be forgotten that 
these two remedies are chemically incompatible, and should not 
therefore be used together. Belladonna appears to have a posi- 
tive curative effect in erysipelas. It is of most service in the 
idiopathic form of the disease, especially the facial variety, and 
not so well suited to traumatic erysipelas. Clinical observa- 
tions go to show that in typhoid and typhus fever it is some- 
times indicated, and may prove very beneficial when there is 
much low, muttering delirium, subsultus and stupor. 

Although in the healthy individual this drug tends to induce 
wakefulness and busy delirium, yet in certain morbid states of 
the brain it appears to have a hypnotic action, and it is consid- 
ered to be indicated in cases of mental disorder in which there 
are found a low state of the blood-pressure, deficient intra- 
cranial circulation, and a contracted pupil, with prostration and 
insomnia. Thus, a hypodermatic injection of atropine may 
overcome the insomnia of delirium tremens in cases where there 
are coma — vigil, great restlessness, and feeble heart-action, with 
coldness of the surface, blue skin, and a clammy sweat. Bella- 
donna was formerly employed to a considerable extent in epi- 
lepsy, but its use in that disease has now been almost entirely 
abandoned, though it is still claimed by some that while in gen- 
eral it is vastly inferior in efficacy to the bromides, yet good 
results may sometimes be obtained from it in nocturnal epilepsy 
and petit mal, and in the case of pale, delicate and anaemic sub- 
jects, with cold extremities, cyanosis, and weak heart. The sub- 
cutaneous use of atropine in neuralgia is of recognized value. It 



8l6 PHARMACOLOGY AND THERAPEUTICS. 

has been found particularly efficient in tic douloureux and sciat- 
ica, and to secure the best results it is advised that deep injec- 
tions of the largest doses compatible with the safety of the 
patient should be made in the vicinity of the affected nerve- 
trunk. Atropine is also very highly recommended in peri- 
uterine and dysmenorrhoeal neuralgia. In traumatic neuralgias 
it is practically worthless. In the treatment of neuralgia in 
general it is inferior to morphine, while its systemic effects are 
usually much more disagreeable than those of the latter. It 
should be resorted to more particularly in the case of patients 
who show an idiosyncrasy against morphine. 



TOXICOLOGY. 

Symptoms. — The most characteristic early symptoms of belladonna 
poisoning are dryness of the mouth and throat, dysphagia, and dilatation 
of the pupil, with dimness of vision. The skin is dry and the scarlati- 
nous rash may or may not be present. The conjunctivae are injected 
and the face is flushed, while the pulse is very markedly quickened and 
the temperature more or less elevated. There is often nausea, and 
sometimes vomiting. There may be purging, but this is not ordinarily 
observed. Frequently the urine is voided at an early period, and after 
that there is a constant desire to micturate without the ability to do 
so. It has been suggested that the preliminary contraction of the 
bladder is analogous to that of the intestine, and the subsequent inability 
to empty it to the diminution of the peristalsis. The patient staggers 
like a drunken man when he attempts to walk, and excitement passing 
into delirium is a prominent feature. The cerebral symptoms have al- 
ready been sufficiently detailed. Convulsions are rare. The respiratory 
movements, which at first are slow and full, become quicker and 
shallower, from the depression of the medullary centre. The breathing 
grows dyspnoeic in character, and death at length takes place from 
respiratory failure. A fatal ending, however, is comparatively infre- 
quent. If the patient should survive, it sometimes happens that he has 
no recollection of his illness. Post-mortem. There is nothing character- 
istic about the appearances, which are simply those met with in 
asphyxia from any cause, the result of venous engorgement of the 
various internal organs. 

Treatment. — Quite commonly the prognosis is favorable, as there is 
usually ample time for a successful treatment. The stomach should 



HOMATROPINE HYDROBROMIDE. 817 

be washed out or evacuated with emetics (see p. 175). The general 
symptoms are best treated by the hypodermatic injection of pilocarpine 
and the delirium by the application of an ice-cap to the head. Chloro- 
form or ether may be used to control spasms. In the stage of depression 
stimulants should be given subcutaneously and strong coffee by the 
rectum. Warmth must be applied to the surface and extremities, and 
artificial respiration may be called for. The effects on the eye may be 
counteracted by the local application of physostigmine, as well as by 
pilocarpine. 

ANTAGONISM. 

The antagonism between atropine and morphine is discussed on page 
864. Morphine might, on theoretical grounds, be administered in the 
early stages of atropine poisoning, but its action on the respiratory 
centre renders its use dangerous in severe cases, for the stimulation 
caused by atropine soon passes into depression, and the effects of the 
two drugs would therefore supplement each other. As a sialogogue, 
diaphoretic and myotic, pilocarpine completely antagonizes the action of 
atropine on the secretory nerve endings in the salivary and sudoriparous 
glands and the terminal filaments of the motor oculi nerve in the iris 
and ciliary muscle. Contraction of the pupil and spasm of the ciliary 
muscle are also induced by physostigmine, which in like manner stimu- 
lates the motor oculi terminations, and it is furthermore antagonistic to 
atropine in that it at once has a depressant action on the respiratory 
centre. 

HOMATROPINE HYDROBROMIDUM.— Homatropine Hydro- 
bromide. Dose, 0.0005 gm. (0.5 milligm.) ; T lj gr. 

Action of Homatropine Hydrobromide. 
Its action appears to be much the same as that of atropine, 
but it is less poisonous and its mydriatic effects, while more 
rapidly produced, are somewhat less complete. It also has the 
effect of slowing, instead of accelerating, the action of the 
heart. 

Therapeutics of Homatropine Hydrobromide. 

It is largely employed for the purpose of dilating the pupil 

in ophthalmic practice, and it has the advantage over atropine 

that the mydriasis passes off in about one-quarter of the time. 

It is therefore better adapted for diagnostic purposes, while 

53 



8l8 PHARMACOLOGY AND THERAPEUTICS. 

atropine is preferable when it is desired to keep the pupil dilated 
for some time, as in the treatment of iritis. It may be used in 
solution, i to 120 of distilled water. Sometimes a solution in 
castor oil is employed, as being less liable to be washed out by 
the tears, but this may produce some irritation. 

Unofficial Preparation. 
Duboisinae Sulphas. — Duboisine Sulphate. 

Action of Duboisine. 

The action of duboisine is practically the same as that of 
atropine. 

Therapeutics of Duboisine. 

It is principally employed in ophthalmic practice, and its 
advantages over atropine are its more rapid action, the shorter 
duration of its mydriatic effects, and the slight degree of con- 
junctival irritation produced by it. Discs containing .000013 
gm. (-g-oVoS 1 *-) are used to dilate the pupil. It has been given 
with alleged good results in puerperal mania, the mental excita- 
bility of the insane, paralysis agitans, and the morphine habit. 
It has also been used in place of atropine in the night-sweats 
of phthisis, respiratory neuroses, cardiac failure, and other 
conditions. 

STRAMONIUM. 

STRAMONIUM (Stramonii Folia, U. S. P., 1890).— Stramonium. 
(Thorn Apple. Jamestown Weed.) Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 

Preparations. 

1. Fluidextractum Stramonii (Extractum Stramonii Seminis, 
U. S. P., 1890). — Fluidextract of Stramonium. Dose, 0.05 C.C.; 

im. 

2. Extractum Stramonii. — Extract of Stramonium. Dose, 
0.010 gm. (10 milligm.) ; i gr. 

3. Tinctura Stramonii. — Tincture of Stramonium. Dose, 0.5 
c.c; 8 TTL. 

4. Unguentum Stramonii. — Stramonium Ointment. 



STRAMONIUM. 819 

Unofficial Preparation. 
Stramonii Semen (U. S. P., 1890). — Stramonium Seed. Dose, 
0.05 to 0.15 gm.; 1 to 3 gr. 

Action of Stramonium. 
The physiological action of stramonium is practically the 
same as that of belladonna, though it is asserted that in poison- 
ing by it irregularity of the heart's action is more marked. It 
also appears to relax the bronchial muscle more completely than 
belladonna. It is generally regarded as more toxic than the 
latter, and accidental poisoning by it, especially among children, 
is quite common. 

Therapeutics of Stramonium. 
Stramonium might, apparently, be employed for all the vari- 
ous purposes of belladonna, but it is not very often used except 
to relieve the spasm of the bronchial tubes in cases where this 
produces the symptom asthma. Here it is of very great value. 
It may be given internally, but most commonly the fumes from 
the burning leaves are inhaled from cigarettes or otherwise, 
and the drug is more beneficial when used in this way. The 
following powder, when burned, is often very efficient in giving 
relief: Powdered leaves of Datura Stramonium, Datura Tatula 
(not official), Cannabis Indica, and Lobelia Inflata, of each, 12; 
nitre in powder, 16; oil of eucalyptus, I. Mix thoroughly. 
Himrod's, Bliss's and other " cures " for asthma are of similar 
composition. Stramonium leaves are sometimes applied locally 
in poultices or fomentations for their anodyne effect, and the 
ointment is more or less used for irritable or malignant ulcers, 
haemorrhoids, fissures and other painful affections, especially 
around the anus. 

HYOSCYAMTJS. 

HYOSCYAMUS.— Hyoscyamus. (Henbane.) Dose, 0.500 gm. (500 
milligm.) ; 7y 2 gr. 

Preparations. 
1. Extractum Hyoscyami. — Extract of Hyoscyamus. Dose, 
0.065 gm. (65 milligm.); 1 gr. 



820 PHARMACOLOGY AND THERAPEUTICS. 

2. Fluidextr actum Hyoscyami. — Fluidextract of Hyoscyamus. 
Dose 0.2 c.c.; 3 IT].. 

3. Tinctura Hyoscyami. — Tincture of Hyoscyamus. Dose, 
1 c.c; 15 m_. 

HYOSCINE HYDROBROMIDUM. — Hyoscine Hydrobromide. 
Dose, 0.0005 gm. (0.5 milligm.) ; ^gr. 

HYOSCYAMINE SULPHAS. — Hyoscyamine Sulphate. Dose, 
0.0005 gm. (0.5 milligm.) ; T ^ gr. 

HYOSCYAMINE HYDROBROMIDUM.— Hyoscyaminse Hydro- 
bromidum. Hyoscyamine Hydrobromide. Dose, 0.0005 gm. (0.5 
milligm.) ; T | ¥ gr. 

SCOPOLAMINE HYDROBROMIDUM. — Scopolamine Hydro- 
bromide. Dose, 0.0005 gm. (0.5 milligm.) ; T | ¥ gr. 

Action of Hyoscyamus. 
As may be inferred from the alkaloidal composition of the 
drug, the action of hyoscyamus is very similar to that of bella- 
donna and stramonium. There are some particulars, however, 
in which it differs, though the difference is really one of degree 
rather than of kind. Thus, under atropine the primary stimu- 
lation of the central nervous system is usually very marked, 
while with hyoscyamus (an effect due to the influence of both 
its alkaloids) the stage of stimulation is much shorter, or may 
apparently be entirely absent. By its depressant action it may 
therefore produce drowsiness and sleep without any preliminary 
exaltation. Both hyoscyamine and hyoscine, as a rule, are 
powerful hypnotics, and the sleep caused by them very closely 
resembles natural sleep. It is to be noted, however, that in 
some instances this is preceded by a stage of excitement, with 
confusion and garrulous delirium, as in the case of atropine, 
while occasionally the hypnotic effect is almost or altogether 
absent. In fact, they may have the opposite effect and cause 
insomnia. Hyoscine is even more depressant to the brain than 
hyoscyamine, and very small amounts are usually sufficient to 
induce sleep. As a rule, no confusion is complained of on 
awaking, but dryness of the throat and thirst are said to be 



HYOSCYAMUS. 821 

often present. As regards the peripheral action, while induc- 
ing the same effects, it is believed that hyoscyamine acts some- 
what more powerfully on the heart, intestine, pupil and sweat- 
glands than atropine, while hyoscine appears to have a still 
stronger action on the peripheral nerve terminations than hyos- 
cyamine, and in man produces no distinct quickening of the 
pulse. Hyoscine is generally said to produce mydriasis and 
loss of accommodation more quickly than atropine, but for a 
shorter period, and according to some observers it acts five 
times more strongly on the pupil than that alkaloid. Scopola- 
mine is chemically identical with hyoscine. 

Therapeutics of Hyoscyamus. 

The preparations of hyoscyamus are weaker than the corre- 
sponding ones of belladonna, and accordingly must be used in 
larger doses. In general, the drug might be employed to ful- 
fill any of the indications for which belladonna is used, but in 
practice it is almost exclusively given for two special purposes. 
As the peripheral action of its alkaloids is more powerful than 
that of atropine, it has more effect in preventing local con- 
tractions of the intestine depending upon nervous stimulation, 
and thus obviating griping, and hence it is very largely given 
with purgatives on this account. In the same way, it has a 
more marked sedative action on the urinary unstriped muscle 
than belladonna, and accordingly it is also much used to relieve 
vesical spasm in the same class of affections in which, as we 
have seen, belladonna is of service. It is very commonly pre- 
scribed with other urinary sedatives, such as buchu, uva ursi, 
or benzoic acid if the urine be alkaline. 

Hyoscyamine and hyoscine (scopolamine) are very power- 
ful alkaloids and should always be administered with great 
caution, especially as the activity of different specimens varies. 
Hyoscine is the less dangerous of the two. Both are used as 
hypnotics to a considerable extent, and especially in hospitals 
for the insane. They often act very satisfactorily in cases of 
mania, delirium tremens, hysteria, etc., and may also be given 



822 PHARMACOLOGY AND THERAPEUTICS. 

for the delirium of fevers and for severe insomnia. Hyoscine 
is the one more commonly used; it is generally given by hypo- 
dermatic injection and is often combined with morphine. Some 
patients, it is found, are not quieted by the drug, but pace up 
and down in a semi-insane condition till its action has worn 
off. It is considered of great value in spermatorrhoea and sem- 
inal emissions. A certain degree of tolerance is produced by 
it, - so that it is necessary to increase the dose from time to 
time in any case where its use is continued for some time. 
These alkaloids have been employed in chorea, paralysis agi- 
tans, locomotor ataxia, and a variety of other nervous affec- 
tions, but apparently without permanent benefit. Hyoscyamine 
often temporarily controls very efficiently the tremor of paraly- 
sis agitans, and it is at times very useful in the treatment of 
the morphine habit, though it should not be given habitually in 
these cases. It is used to some extent in ophthalmic practice. 

SCOPOLA. 

SCOPOLA.— Scopola. Dose, 0.045 gm. (45 milligm.) ; % gr. 

Preparations. 
i. Extractum Scopolae. — Extract of Scopola. Dose, 0.010 gm. 
(10 milligm.) ; * gr. 

2. Fluidextractum Scopolae. — Fluidextract of Scopola. Dose, 
0.05 c.c; 1 n\. 

SCOPOLAMINE HYDROBROMIDUM. — Scopolamine Hydro- 
bromide. Dose, 0.0005 gm. (0.5 milligm.) ; T ^ f gr. 

Action of Scopola. 
Scopola is a mydriatic, analgesic and hypnotic. Its action 
appears to be identical with that of belladonna in kind, though 
differing somewhat in degree. Thus, scopola is to some extent 
more depressant to the spinal cord and is decidedly more toxic. 
Like belladonna, it has been found to raise the blood-pressure, 
paralyze the vagus terminations, and primarily stimulate the 
respiratory centre, while in lethal amounts it causes death by 



SCOPOLA. 823 

asphyxia. In the frog it is stated to be a paralyzant to the 
spinal cord and to Setschenow's centre, and, when brought in 
direct contact with a motor nerve, to lessen its function. From 
the fact that, as mentioned, scopola is slightly more depressant 
to the cord and is also considerably more toxic than belladonna, 
it is believed that the dominant alkaloids of the two drugs are 
probably not identical. As regards effects upon the eye, sco- 
pola acts much more promptly, but for a shorter time, in dilat- 
ing the pupil and slightly increasing the tension of the globe, 
while the systemic effects are more pronounced than from bella- 
donna. The general conclusions which have been derived from 
a series of recent researches by a number of different investi- 
gators are as follows: While scopola is more depressing and 
toxic than belladonna, yet when administered externally it 
shows almost no tendency toward absorption to the extent of 
producing systemic effects. When it is absorbed, however, it 
acts locally with promptness and energy. As regards the eye, it 
effects are more rapid and less prolonged. In all the other ways 
experimented with it acts more efficiently, with the exception of 
the matter of plasters, where it is slightly less efficient than 
belladonna. Scopola exhibits a distinct superiority over bella- 
donna root in its greater uniformity of alkaloidal percentages. 
The predominating alkaloid of scopola is hyoscyamine in an 
almost pure condition. 

Therapeutics of Scopola. 
Scopola has been employed for a number of the same pur- 
poses as belladonna. It is to be noted, however, that while 
belladonna is active, scopola is nearly inert, when used by in- 
unction either in the form of the pure fluidextract or in lini- 
ment. It is apparently more efficient than belladonna when 
used as a solid extract to dry the milk in breasts after wean- 
ing. It is advised that the drug should not be given when renal 
disease is present, nor in advanced age. Scopolamine hydro- 
chloride is employed, in solutions of from T L to J per cent, in 



824 PHARMACOLOGY AND THERAPEUTICS. 

eye practice and by hypodermatic injection in hospitals for the 
insane. 

ALCOHOL. 

i. ALCOHOL.— Alcohol. (Ethylic Alcohol. Spirit of Wine.) 

Preparation. 
Alcohol Dilutum. — Diluted Alcohol. (Proof Spirit.) 

2. ALCOHOL ABSOLUTUM.— Absolute Alcohol. 

3. SPIRITUS VINI GALLICL— Brandy. 

4. SPIRITUS FRUMENTL— Whiskey. 

5. VINUM ALBUM.— White Wine. 

6. VINUM RUBRUM.— Red Wine. 

Unofficial Preparation. 
Alcohol Deodoratum (U. S. P., 1890). — Deodorized Alcohol. 

Action of Alcohol. 
External. — Alcohol is antiseptic and disinfectant, but it has 
comparatively little bactericidal action at the temperature of 
the body. 50 to 70 per cent, alcohol is said to be more destruc- 
tive to germs than either stronger or weaker solutions. Curi- 
ously enough, it has been pointed out that many substances 
which are antiseptic when dissolved in water lose much of this 
property when dissolved in alcohol, and it seems to be an estab- 
lished fact that the presence of alcoholism, whether acute or 
chronic, actually predisposes to bacterial infection. This is a 
matter of common observation in the human subject, and has 
been demonstrated repeatedly in experiments on animals, whose 
power of resistance is diminished by alcoholization. Alcohol 
is both refrigerant and rubefacient, and is also astringent, an- 
hydrotic and slightly anaesthetic. Applied to the skin, it quickly 
evaporates ; thereby cooling the surface, with the effect of tem- 
porarily constricting the superficial vessels and checking the 
secretion of the sweat-glands. If, however, evaporation is pre- 
vented, as by covering the spot with a watch-glass or piece of 



ALCOHOL. 825 

rubber, or by rubbing the application in, the alcohol (which has 
the property of extracting water from all tissues) promptly 
absorbs moisture from the skin, and thus has the effect of hard- 
ening it. Having passed through the epidermis, it exerts an 
irritant action, similar to that of the volatile oils, which pro- 
duces a dilatation of the vessels and redness, itching and a sen- 
sation of heat in the part. It also causes a temporary pre- 
cipitation of albumins. Upon ulcers and abraded surfaces the 
irritant action is much more marked. The albumin is coagu- 
lated and there is first an astringent and afterwards a corrosive 
effect, until the alcohol becomes diluted by the fluids of the 
wound. 

Internal. Mouth. — Upon the mucous membrane of the mouth 
and pharynx concentrated solutions cause effects similar to 
those on the skin when evaporation is prevented, but there is 
more of a burning sensation produced, and at once also there 
results, from reflex action, an increased flow of saliva and pos- 
sibly a quickening of the pulse. Then follows a slight local 
anaesthesia, and if the alcohol is held in the mouth for some 
time, the mucous membrane becomes whitish and opaque, from 
coagulation of albumin and abstraction of water from the tis- 
sues. This soon disappears, as resolution of the albumin 
occurs. 

G astro -intestinal Tract. — In the stomach also a burning sen- 
sation is produced by concentrated solutions, and large quanti- 
ties give rise to so much local irritation that nausea and vomit- 
ing are caused. In animals it has been demonstrated that alco- 
hol, when given in moderate amount, induces, by its irritant 
action on the walls of the stomach, an increased cell activity, 
a more active circulation, and a more rapid secretion of both 
acid and solids of the gastric juice; also that gastric peristalsis 
is augmented and the absorption of fluids from the stomach and 
intestine much accelerated. In man the same effects have been 
observed in cases of gastric fistula, and it has generally been 
found by experimenters that the digestion is promoted. In 
some instances, however, in which observations on the dura- 



826 PHARMACOLOGY AND THERAPEUTICS. 

tion of gastric digestion with and without alcohol were made, 
it was found that the process was retarded, instead of being 
accelerated, by this agent. To explain this discrepancy it has 
been suggested that the effect must vary in different individ- 
uals, and that it is not unlikely that the taste has some influence 
on the result; so that in those who enjoy the taste of alcohol 
it induces a more rapid secretion and an improved digestion, 
while in those to whom it is disagreeable, the secretion is in- 
hibited. In general, it may be said that alcohol in moderate 
amounts tends to favor the process of digestion through an 
increased secretion of gastric juice, increased gastric move- 
ment, and increased absorption. With a percentage above 15, 
these are found to be counteracted by the lessened ferment 
action; so that the actual result will depend upon which of 
these two — the beneficial irritant or the deleterious anti-ferment 
action — predominates. Small amounts of weak alcohol taken 
at meals, it would seem, therefore, can scarcely have a bad 
effect upon digestion, and may be of service in promoting it. 
The primary effect of the irritation of the gastric mucous mem- 
brane is to sharpen the appetite, and this explains the quite 
common custom of taking a little alcohol just before meals. 
Furthermore, the local anaesthetic effect of alcohol may at 
times prove useful in relieving gastric pain. Alcohol is unique 
in one respect, no other known substance, it is said, having this 
effect: it causes the gastric glands to secrete when it is intro- 
duced into the small intestine or even into the rectum. It would 
seem, therefore, that it may act generally throughout the whole 
intestinal canal, to stimulate the flow of the gastric juice. In 
addition, alcohol by promoting the latter, indirectly promotes 
the pancreatic secretion also, since it has been shown that the 
chief stimulus to the flow of pancreatic juice is the action of 
the hydrochloric acid of the gastric juice upon the wall of the 
duodenum. The injection of a single dose of alcohol in concen- 
trated form, as pure brandy, is immediately followed by pro- 
nounced reflex effects. Thus, the action of the heart is accel- 
erated and increased in force, the blood-vessels generally, and 



ALCOHOL. 827 

particularly those of the skin, become dilated, giving rise to a 
feeling of warmth throughout the body, and the blood-pressure 
rises. The respiration is also quickened. These reflex effects, 
which are not produced by dilute forms of alcohol, such as 
beer, are well shown in the immediate restoration of a faint- 
ing person by a dose of brandy. They are quickly followed by 
the action on the circulation of the alcohol after its absorption 
into the blood. The repeated use of large amounts of alcohol 
leads to persistent congestion of the mucous membrane, and, if 
long continued, to chronic gastritis. The activity of the gas- 
tric juice is soon impaired and afterwards lost, the gastric 
glands atrophy, an excessive amount of mucus is secreted, and 
the permanent dyspepsia of drunkards results. In the intes- 
tines alcohol ordinarily has a slightly astringent effect. In 
drunkards, however, there usually results a catarrhal enteritis, 
as well as gastritis. 

Metabolism. — About 90 per cent, of the alcohol absorbed from 
the alimentary tract is found to undergo combustion. In doing 
so it gives up energy to the body, and is therefore to be con- 
sidered as a food, though the mere fact of its transmission of 
energy does not constitute it an advisable food in all conditions. 
Alcohol ceases to be a food when it is ingested in such large 
amounts that it cannot be completely oxidized. In this in- 
stance the excess is likely to be harmful. Taken in addition 
to the ordinary food, alcohol is either itself transformed into 
tissue, or undergoes oxidation in the place of some substance 
which in turn is utilized to build up the body. It has been 
shown that alcoholized animals lay on more fat than others 
receiving the same food without alcohol, and it is a familiar 
fact that in the human subject habitual drinkers evince a 
marked tendency to obesity. It is evident, therefore, that to 
some extent, at least, alcohol acts as a substitute for fats and 
carbohydrates in the food. While, however, it is well known 
that these principles can without any injurious effect be sub- 
stituted for a certain amount of the nitrogenous food required 
by the system, it is as yet an undetermined question how far al- 



828 PHARMACOLOGY AND THERAPEUTICS. 

cohol, although undergoing combustion in the tissues and leading 
to the deposition of fat, is able to replace the fats and .carbo- 
hydrates in their relation to nitrogenous metabolism. As far 
as can be judged, it would seem that while alcohol really tends 
to prevent the waste of fats and carbohydrates, it is probably 
of less value than the latter in economizing nitrogenous waste; 
so that if alcohol is used as a food it should be associated with 
a diet rich in albuminous matter. Under these circumstances it 
is believed to be capable of replacing to some extent the ordinary 
food-stuffs. The only way in which alcohol, in moderate 
amounts, is supposed to have any action on the tissues is as a 
food, since the oxidation of the tissues, as measured by the 
absorption of oxygen and exhalation of carbon dioxide, is af- 
fected only in the same way as by any other food. When 
excessive quantities of alcohol are taken, the combustion of the 
tissues is first greatly augmented by the violent movements 
characterizing the stage of excitement, but later it becomes 
reduced from the lessening of the rri'uscular movements in con- 
sequence of the stupor and depression induced. Naturally, fats 
are saved from combustion by the oxidation of alcohol by the 
tissues, and it is thought possible that in the case of some other 
bodies also, as benzene, the energy which would ordinarily be 
expended in their oxidation, is diverted to that of the alcohol. 
The observations on the effect of alcohol in moderate doses on 
nutrition have led to the following conclusions : ( I ) With a 
diet on which the individual gains in weight, the addition of 
alcohol lowers the rate of increase; (2) when added to a diet 
on which the weight remained constant, it tends to cause a loss 
of weight; (3) with insufficient diet, it lessens the loss of 
weight, or may even cause a gain. 

Blood and Circulation. — On the leucocytes of the blood it 
has the effect of first augmenting and then reducing the amoe- 
boid movements; while as regards the red corpuscles it inter- 
feres with the ready yielding up of its oxygen by the oxyhemo- 
globin, and thus tends to retard oxidation in the tissues. The 
reflex effects of alcohol on the circulation have been referred 



ALCOHOL. 829 

to in connection with its influence on the alimentary tract. Its 
action on the circulation after absorption has been the subject 
of much controversy. There is always a quickening of the 
heart during the excitement of alcoholic intoxication, but there 
is reason to believe that this is due to the increased muscular 
movement, rather than to any direct action on the heart. It 
has been shown that in normal cases the pulse-rate is unaf- 
fected by alcohol, provided that no excitement be produced by 
the environment, and this also remains unaltered in animals, 
unless a very large amount of alcohol is administered. In that 
case there are induced weakening of the auricular systole and 
afterwards of the ventricular, with distention of both cavities 
and slowing. It has been pointed out that these effects are 
similar to those caused by ether and chloroform, though the 
influence on the heart is very much less marked than in the 
case of these drugs. Whatever action alcohol has as regards 
the heart appears to be on the cardiac muscle. While it has 
been claimed that it increases the force of the contraction, 
proof, of this is lacking, and, on the contrary, experiments on 
animals have indicated that the first effect of alcohol on the 
heart is diminished efficiency and weakness of the contractions. 
In alcoholic intoxication one of the most noticeable features 
relating to the circulation is the flushing of the cutaneous sur- 
face. This can be attributed only to dilatation of the vessels 
of the skin, but it is undetermined whether such dilatation is 
the result of stimulation of the dilator centres or paresis of the 
vaso-constrictors. This action apparently has very little effect 
on the general blood-pressure. A marked fall in this is caused 
by very large amounts of alcohol, which weaken the muscular 
tissue of the heart and depress the vaso-constrictor centres ; but 
no such effect is to be expected from medicinal doses. In fever 
the heart is frequently slowed by the administration of alcohol, 
and the results of study of its influence on the circulation would 
seem to indicate that this is due to its effect in diminishing 
cerebral excitement, rather than to any direct action on the 
heart. In shock, whatever improvement in the circulation may 



83O PHARMACOLOGY AND THERAPEUTICS. 

follow the use of alcohol is to be attributed to the reflex influ- 
ence from its local irritant action which has already been men- 
tioned. It would appear that the reputation which alcohol has 
long enjoyed as a cardiac stimulant is not altogether supported 
by fact; but, at the same time, there can be no question that it 
is often of value in circulatory disorders for this reason, if for 
no other, that by its cerebral action it tends to lessen anxiety 
and other mental symptoms. 

Respiration. — While experimenters now agree as to the main 
facts in the action of alcohol on the respiratory function, the 
interpretation of these is still a matter of dispute. During the 
excitement of alcoholic intoxication the respiration is usually 
quickened, and this may be due simply to the increased mus- 
cular activity rather than to a stimulation of the respiratory 
centre in the medulla. Such excitement is not induced by 
therapeutic doses, but the evidence at command goes to show 
that without this the amount of air inhaled is generally in- 
creased by alcohol, and such increase has even been noted in 
some cases where a well-marked narcotic effect was present. 
At present it is impossible to say whether the augmentation of 
the air inhaled is due to direct action on the respiratory centre 
or to reflexes arising from the stomach, to both of which agen- 
cies it has been attributed by different observers. This is a 
question of practical importance in cases in which the respira- 
tion is insufficient, and not one of merely theoretical interest; 
for, it has been pointed out, if the augmented respiration is 
caused only by the local action in the stomach, this indicates 
that much of the surplus oxygen is used in doing the work of 
absorbing the alcohol, and that the rest of the body profits to 
a correspondingly small extent from the increased aeration. 
On the other hand, if the air inspired is augmented in a greater 
ratio than the products of the increased activity of the alimen- 
tary tract, as is the case when the respiratory centre is directly 
stimulated, the advantage to the organism is correspondingly 
great. On the whole, it would seem that while the use of 
alcohol as a respiratory stimulant is not actually supported by 



ALCOHOL. 83I 

experimental investigation, it is nevertheless not to be entirely 
condemned. 

Nervous System. — Alcohol is very generally regarded as a 
central nervous stimulant, which first excites and then depresses 
the cerebral and other cells. It should be stated, however, that 
the majority of experimental observers lean to the view that 
the stimulation is apparent rather than real. Their explana- 
tion of the cerebral excitement caused by alcohol is that it is 
due, not to the augmented vitality of the nerve cells, but to a 
loss of the associations which ordinarily retard the expression 
of mental activity. Their argument against the stimulant ac- 
tion of alcohol is based on the narrow limits to which this is 
confined. While it is true that all the central nervous stimu- 
lants act on some particular part, in small doses, it is found 
that when larger amounts are employed, the stimulant action 
spreads over a wider area of the central nervous system and 
gives rise to the symptoms characteristic of stimulation of that 
area. Alcohol, they claim, appears to have only a depressant 
action on the nervous tissues, except in the human cerebrum; 
though it is true that the exceptional development of the human 
brain might permit of a departure which is without analogy 
with other forms of poisoning. The conclusion arrived at by 
them is that the investigations thus far made point strongly to 
the correctness of the theory that alcohol really acts as a nar- 
cotic. The acceptation of this theory, they hold, is by no means 
equivalent to condemning the therapeutic use of alcohol for its 
effects on the brain, but, on the contrary, it is maintained that 
the narcotic or depressant action of alcohol, far from being in 
conflict with its clinical use, supplies a definite and logical ex- 
planation of the improvement noted in a large number of in- 
stances where the effect of alcohol in allaying the subjective 
symptoms, relieving the nervous strain, and promoting the rest 
and comfort of the patient is not surpassed by that of any other 
drug. Accordingly, it would seem a question whether the re- 
sults aimed at by the clinician when he prescribes alcohol have 
not been misnamed stimulation, and are not in reality narcotic 



832 PHARMACOLOGY AND THERAPEUTICS. 

in their nature, and hence in entire agreement with the experi- 
mental results. The clinician, it is suggested, in applying the 
term stimulant to alcohol, uses the word in quite a different 
sense from that in which it is understood by the experimental 
observer — his meaning is less definite, and he wishes to indi- 
cate only the improvement often noted in the general condi- 
tion, without considering whether this is due to an augmenta- 
tion or a retardation of the mental processes. The view gen- 
erally accepted in the medical profession is that alcohol is a 
powerful nervous as well as cardiac stimulant, and that the 
increased functional activity which it induces, especially in the 
nervous system, is followed by a period of diminished activity 
or depression ; furthermore, that alcohol, like many other drugs, 
acts on the higher functions first, so that the stimulation and 
the subsequent depression proceed in a descending scale from 
the highest or least firmly fixed function to the lowest or most 
firmly fixed, in accordance with the Law of Dissolution (see 
p. 737). In the highest centres the special effect produced by 
alcohol appears to depend on the nature of their activity in the 
individual. In many individuals moderate amounts increase 
the facility of speech and in exceptional instances the brilliancy 
of thought. It must be acknowledged, however, that some of 
the highest functions of the brain are thrown out of action by 
doses of the drug which induce the. phase of exhilaration. 
Thus, while a person may show greater brilliancy in conversa- 
tion and generosity of sentiment, he is apt to lack that con- 
sideration for his own position or that of others which he ordi- 
narily manifests, and to lose his self-control and self-restraint, 
his sense of responsibility and his power of discrimination. 
Such results would be explained, according to the stimulant 
theory, by the brief period during which the activity of the 
highest centres is augmented; so that the power of judgment 
becomes abolished very early, while the imagination, the emo- 
tions, and the power of speech are still in increased activity. 
These various functions then successively fail in the order 
named, and after them the muscular movements, commencing 






ALCOHOL. 833 

with the more delicate, become first incoordinated and then 
paralyzed. If the quantity of alcohol taken is sufficiently large, 
the reflex activity of the spinal cord next becomes abolished, 
and the bladder and bowels are evacuated involuntarily. The 
comparative immunity from injuries in falling, etc., which is 
often noted in drunken people, is believed to be due to the 
depression of the reflex centres of the cord, since the heart 
and respiration, on account of the general central depression, 
are not affected reflexly by them. After the spinal centres, the 
respiratory centre in the medulla fails, and finally the heart 
may be paralyzed and death result. A fatal issue of the poison- 
ing, however, is exceptional, and generally recovery takes place 
after a prolonged sleep. This is deep and torpid, passing into 
total unconsciousness, with slow and stertorous breathing, while 
the face, which has hitherto been flushed, grows pale or cyan- 
otic. If unconsciousness continues for more than ten or twelve 
hours, it is said that a fatal result is almost certain to occur. 
It has been conclusively shown that regiments supplied with 
alcoholic liquors are less capable of long marches and suffer 
more from fatigue than others without them, and, in addition, 
that the capacity for forms of work in which more mental 
activity is required than by marching soldiers is lessened by 
alcohol. Thus, when even a small quantity of alcohol is al- 
lowed, typesetters do a less amount of work and make a larger 
number of errors than when they are not supplied with it, 
while students exhibit a diminished capacity for mental work 
and less ability to keep the attention concentrated. The ten- 
dency toward sexual excess frequently observed after alcohol 
is not due to any influence upon the generative organs them- 
selves, but to the loss of control from the cerebral action of 
the drug. 

Temperature. — Small doses of alcohol have no effect on the 
body-temperature, although, in consequence of the dilatation of 
the gastric and cutaneous blood-vessels induced, they cause a 
sense of warmth both internally and on the surface. Moderate 
amounts (30 to 90 c,c r ; 1 to 3 fl. oz.) cause a fall of .5° C, 
54 



834 PHARMACOLOGY AND THERAPEUTICS. 

and this without causing intoxication. The reduction of tem- 
perature is believed to be due chiefly to a loss of heat from 
the dilatation of the cutaneous vessels. This is usually accom- 
panied by a feeling of warmth, and a thermometer applied to the 
skin may actually show a rise of several degrees, in consequence 
of more warm blood flowing through the vessels. If much 
excitement and movement are caused by the drug, the increased 
heat resulting may counterbalance the augmented output; so 
that there may be no fall in the temperature, and in some cases 
even an elevation may be observed. Narcotic doses generally 
cause a fall amounting to from 3 to 5 C, which is due to the 
lessened movements during unconsciousness and may last for 
a considerable time. During exposure to cold a more marked 
reduction of temperature than under ordinary conditions ap- 
pears to be caused by alcohol, in consequence, perhaps, of its 
rendering the heat-regulating mechanism less sensitive. Alco- 
hol is, therefore, very unsuitable for a person who has to be 
exposed to severe cold. Besides, it causes drowsiness, and in 
this way dangerous results and even death may occur from a 
free indulgence in liquor under these circumstances. 

Skin. — Alcohol is a mild diaphoretic, the action of the sweat- 
glands being augmented by the dilatation of the cutaneous ves- 
sels and also possibly by some direct influence on the glands. 

Kidneys. — Alcohol has some diuretic influence, but it is un- 
known whether this is due at all to a direct action on the 
kidney. Some of the spirituous liquors, such as gin, induce 
free diuresis, but this is owing to the other constituents rather 
than the alcohol. 

Excretion. — The small percentage of alcohol which is not 
oxidized in the tissues is excreted unchanged, principally by 
the lungs and kidneys and to a very much less extent in the. 
sweat and milk. The exact amount thus eliminated varies with 
the quantity taken. If the amount ingested is very large, about: 
0.3 per cent, escapes in the milk, but if moderate, none. The 
popular notion that an infant may become intoxicated or acquire 
a taste for spirituous liquors from the alcohol absorbed in the 



ALCOHOL. 835 

milk of a drunken mother or wet-nurse is without any founda- 
tion in fact. Both the amount and quality of the milk are said 
to be unaffected by the administration .of alcohol. When me- 
dicinal doses are taken, it is found that the quantity excreted 
through the lungs amounts to 5 l / 2 to 6 1 /- per cent., and through 
the kidneys at most to 1 to 2~/ 2 per cent., while none is elim- 
inated by the skin. Alcohol has been demonstrated in the blood 
for twenty-four hours after intra-venous injection of large 
quantities. 

Tolerance is produced by the continued use of alcohol, and 
hence it is necessary to prescribe much larger doses in the case 
of habitual drinkers than for other persons. 

Therapeutics of Alcohol. 
External. — Alcohol is used as an evaporating lotion for 
sprains, bruises and local inflammations generally. A common 
form is the Lotio Spiritus, which is found in many hospital 
pharmacopoeias, and which consists of 4 parts of rectified spirit 
to 1 of water. This is applied to the affected part upon a single 
layer of lint or cotton, and allowed to evaporate. Diluted alco- 
hol, 3, with lead-water, 1, to which some morphine acetate may 
be added if the pain is severe, is also employed in the same 
way. Headaches are often relieved by the refrigerant and an- 
aesthetic effect of alcohol when used in the form of bay rum 
or eau de Cologne to bathe the forehead, and spirit lotions, in 
consequence of their effect in constricting the cutaneous blood- 
vessels, may be of service in checking undue sweating. Brandy 
or ordinary alcohol is a good application for hardening the 
skin to prevent cracking of the nipples in nursing women and 
also for the prevention of bed-sores. Its efficiency for this 
purpose may be increased by the addition of a little alum. The 
rubefacient property of alcohol may be availed of for promoting 
the absorption of inflammatory products, or for the relief of 
pain in such affections as myalgia and chronic rheumatism, by 
rubbing it in the skin in the form of Linimentum Saponis and 
other liniments into which it enters. Hot applications of alco- 



836 PHARMACOLOGY AND THERAPEUTICS. 

hol also alleviate pain, and a favorite method for securing re- 
lief in facial neuralgia, toothache, and various other painful 
conditions is the use of a flannel hop-bag which has been 
dipped in hot whiskey. A little brandy held in the mouth will 
also frequently relieve toothache. Properly diluted, alcohol 
may be employed as an astringent and antiseptic gargle or 
mouth-wash in pharyngitis, stomatitis, scurvy, salivation, etc. 
Port wine is very commonly used for this purpose. Concen- 
trated alcoholic preparations are of service in the treatment 
of frost-bite, ulcers, loss of hair, freckles, and certain vegetable 
parasitic diseases. Alcohol dressings have been found valuable 
in tuberculous lesions and to relieve the pain of herpes zoster, 
and the local application of alcohol is said to be an effective 
abortive measure in- herpes. 

Internal. — Used with careful discrimination, alcohol is one 
of the most valuable remedies we possess. It is not to be 
recommended in acute dyspepsia, as it is then apt to be irri- 
tant to the gastric mucous membrane, but given before or with 
the meals it is in many instances of service in sharpening the 
appetite and improving the digestion, especially in the seden- 
tary, aged and feeble, and in cases of exhaustion from acute 
disease or over-work, where the stomach is naturally affected by 
the general condition. Sometimes it is best administered after 
eating. On account of its anaesthetic effect, alcohol, as has 
been mentioned, may relieve gastric pain, and it is also some- 
times useful in allaying nausea and vomiting, particularly when 
given in the form of champagne or of brandy in small doses 
with pounded ice or effervescent mineral waters. When in 
delirium tremens nothing is retained on the stomach, so that 
the patient's life may be endangered on account of the lack of 
nutriment, a little brandy and ice will sometimes settle the 
stomach, and thus enable it to receive and digest the food so 
urgently needed. In cholera infantum and in other diarrhceal 
affections, in adults as well as children, brandy is at times very 
useful, and port wine is also employed in diarrhoeas. Alcohol 
may relieve intestinal as well as gastric colic, but gin and hot 



ALCOHOL. 837 

water has too often been relied upon by old nurses in the flatu- 
lence of infants and young children when proper attention to 
the feeding would have prevented the indigestion. Alcohol is 
of immense advantage in many cases of febrile disease, where 
during critical periods it sustains the vital powers by supple- 
menting the insufficient quantity of nutriment which the sys- 
tem is capable of appropriating; at the same time stimulat- 
ing the digestion, and thus enabling the patient to dispose of 
an increased amount of food. It is advisable under these cir- 
cumstances, therefore, that it should be given with milk, broth, 
eggs or other suitable aliment. It is by no means adapted for 
all cases of fever, and hence its effects should always be very 
carefully watched. If under its use the pulse becomes stronger 
and fuller, the tongue and skin less dry, the respiration less 
embarrassed, the delirium and subsultus less marked, and the 
patient grows more tranquil and disposed to sleep naturally, 
we may know that the drug is doing good. Although it is not 
given as an antipyretic, in cases in which it thus acts bene- 
ficially it will usually be found that the temperature is more or 
less reduced by it. On the other hand, if the fever rises and 
the other effects produced are the opposite of those just men- 
tioned, the alcohol is doing harm and should be discontinued. 
While it is often given when it is quite unnecessary, there are 
many instances in which it is of inestimable value in such affec- 
tions as typhoid and typhus fevers, pneumonia, small-pox, 
cholera and diphtheria, and also in gangrene, pyaemia, septi- 
caemia, etc. It is also of the highest usefulness to arouse and 
support the flagging powers in sudden depression of the sys- 
tem, and may be given by the mouth, by the rectum, hypoder- 
matically, or applied to the external surface with friction. It 
is thus resorted to in shock, syncope, severe haemorrhage, and 
poisoning by tobacco, digitalis, antimony, conium, chloroform, 
ether, etc. In snake-bite and poisoning by carbolic acid it may 
not only serve to tide the system over until the poison is elim- 
inated, but also to directly antagonize the latter in the blood, 
and it therefore constitutes the best antidote in these cases. 



838 PHARMACOLOGY AND THERAPEUTICS. 

The beneficial effect of the reflex stimulating action of alcohol 
on the circulation is well shown in cases of fainting or collapse 
from cold or other cause, where a single dose of strong spirits 
often promptly revives the patient. Alcohol may be said to be 
indicated in general whenever adynamia is a pressing symptom, 
and should then always be employed, tentatively at least, unless 
there are special circumstances present which render its admin- 
istration unadvisable. In acute disease frequently, and more 
rarely in chronic conditions, it is given with excellent effect in 
quantities which in health would cause intoxication and alto- 
gether disastrous results. The case is recorded by an eminent 
clinician of a young woman suffering from pulmonary tuber- 
culosis who took one pint of whiskey daily for nearly two years 
and who finally recovered from the disease. In many instances 
of tuberculosis and other wasting diseases it is a remedy of the 
greatest service, lessening tissue-waste, promoting constructive 
metamorphosis, favoring the deposition of fat, and in general 
tending to retard the progress of the disease. The narcotic 
effect of alcohol on the nervous system may be employed to 
relieve pain, to promote sleep, and to quiet delirium, but except 
in the case of acute disease it should be resorted to for these 
purposes with the greatest possible discriminating judgment, on 
account of the patient's moral welfare. When given as a di- 
uretic, it is usually in the form of gin, in which its effect is 
greatly augmented by the juniper contained in this liquor. Al- 
though but little alcohol is excreted by the kidneys, its abuse, 
particularly in the form of ardent spirits, is one of the recog- 
nized causes of chronic Bright's disease. In all inflammations 
of the urethra it seems to be irritating, and in the treatment of 
gonorrhoea is always interdicted to the patient. Beer is re- 
garded as particularly harmful. Among the other contraindi- 
cations for the use of alcohol may be mentioned acute nephri- 
tis, all states of cerebral excitement, unless due to exhaustion, 
apoplexy, meningitis, aneurism, advanced atheroma, and the 
alcoholic habit. For its diaphoretic effect, a glass of hot spirits 
and water, taken at bedtime, is frequently employed to break 



ALCOHOL. 839 

up an incipient cold. In malarious regions it is a common 
practice to take whiskey with quinine as a prophylactic against 
intermittent fever. 

TOXICOLOGY. 

Very large quantities of alcohol are capable of causing instantaneous 
death by reflex arrest of the heart, but such a result is rare. Commonly 
they induce a torpid sleep which gradually deepens into a condition like 
that seen in chloroform anaesthesia, and which may end in death, usually 
from respiratory failure. In some fatal cases convulsions have pre- 
ceded death. When the patient is first seen in the advanced stage of 
deep coma, the absolute diagnosis of acute alcoholic poisoning cannot be 
made out. 

Chronic Poisoning. — Among the more common results of chronic 
poisoning by the drug are chronic gastritis, cirrhosis of the liver, 
delirium tremens and mania. A great variety of other serious diseases 
have been attributed to its effects, among which may be mentioned 
gout, peripheral neuritis, pachymeningitis, organic heart disease, and 
chronic nephritis. There are, in fact, but few organs and tissues not in 
some way changed in chronic alcoholism, and its results, from their 
frequency and importance, have come to claim the attention of syste- 
matic writers on the practice of medicine. Changes met with. It need 
only be said here that the changes met with have been classified under 
two groups, sclerosis and steatosis. While these anatomical alterations 
are developing, the exterior of the body assumes characteristic appear- 
ances. The subject may either be pale and flabby, but fat, with a 
heavy and imbecile expression, or have a dusky red or purplish, pimply 
and bloated skin, with bulging under the eyes, yellow and injected con- 
junctivas, and blue and swollen lips. Alcoholics are especially liable to 
contract pneumonia, tuberculosis and other infectious diseases, and when 
attacked by them show less powers of resistance than most other per- 
sons. They are also bad subjects for surgical operations. It is possible, 
however, that some of the bad effects resulting from the use of alcoholic 
drinks may be due to other substances than alcohol contained in them. 

Unofficial Preparation. 
Alcohol Amylicum.— Amylic Alcohol. (Fusel Oil.) 

Action of Amylic Alcohol. 
This substance is present in small quantity in most forms of 
spirits, especially when these are freshly distilled. It has a 



84O PHARMACOLOGY AND THERAPEUTICS. 

more violent acute action and more pronounced after-effects 
than ethylic alcohol. 

Therapeutics of Amylic Alcohol. 
Fusel oil is a poison, and is not used in medicine. The manu- 
facturers of cinchona alkaloids employ it as a solvent; formerly 
it was required for the preparation of valeric acid. 

CANNABIS INDICA. 

CANNABIS INDICA. — Indian Cannabis. (Indian Hemp.) Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Extractum Cannabis Indicae. — Extract of Indian Cannabis. 
Dose, 0.010 gm. (10 milligm.) ; £ gr. 

2. Fluidextractum Cannabis Indicae. — Fluidextract of Indian 
Cannabis. Dose, 0.05 c.c; 1 Hi. 

3. Tinctura Cannabis Indicae. — Tincture of Indian Cannabis. 
Dose, 0.6 c.c; 10 ni. 

Action of Cannabis Indica. 

External. — None. 

Internal. — The action of cannabis indica seems to have many 
features in common with that of opium, and even more closely 
resembles the action of anhalonium (see Pellotine, p. 877). Its 
principal influence is on the cerebrum, and it is regarded as per- 
haps the most powerful stimulant of the psychic functions 
known. It is largely employed for this purpose in the Orient 
(often in the form of haschisch) , and its moderate use does not 
appear to be attended by any injurious effects. When taken to 
excess, it leads to tremor and loss of appetite and strength, and 
sometimes to mania and dementia. In some cases convulsive at- 
tacks have been observed, and among the natives of India cata- 
lepsy is said to occasionally occur. If the drug were generally 
used by Caucasians, it is thought that the effects would probably 



CANNABIS INDICA. 84 1 

be more serious than is usual among Orientals. Death from 
acute poisoning is stated to be extremely rare, and recovery has 
taken place after enormous doses. At the same time, experi- 
ments on dogs have shown that it undoubtedly presents some 
danger. In the influence of cannabis indica upon the nervous 
system depression is mixed with the stimulation in a manner 
similar to that which is occasionally seen in the case of morphine. 
Within a short time after taking it the patient experiences the 
most pleasurable emotions. Everything seems to amuse him, 
and he becomes hilarious and indulges in actions which he may 
know to be ridiculous but which he cannot restrain. Double 
consciousness is now well marked; in fact the ego may become 
a severe critic of the alter ego. In the exuberance of his spir- 
its he feels on the best possible, and even affectionate, terms 
with everyone about him. He passes in^o a dreamy, semi- 
conscious state, in which, while the judgment is practically lost, 
the imagination runs riot. All his ideas are on a grand and 
magnificent scale; time and space seem to be indefinitely ex- 
tended. He may say brilliant or witty things, but there is little 
continuity in his thought, which changes rapidly from one sub- 
ject to another. Delightful visions pass before him in an end- 
less phantasmagoria. True hallucinations are sometimes present 
and sometimes not. The general sensibility is much dimin- 
ished, and this effect may deepen into complete anaesthesia. 
The pupil is usually somewhat dilated. As the system becomes 
more profoundly influenced by the drug the dreams alternate 
with periods of consciousness, and eventually there results a 
tranquil sleep. From this the patient usually awakens without 
any feeling of depression, but refreshed and with an acute sense 
of hunger. Occasionally, in the midst of the pleasurable 
thoughts there is experienced a feeling of impending danger or 
other disagreeable sensation, and in some instances melancholia 
precedes the stage of sleep. In the Caucasian race the primary 
stage of exaltation may be quite short, and is sometimes alto- 
gether absent, deep sleep coming on after a preliminary feeling 
of heaviness and drowsiness, with noises in the ears and numb- 



842 PHARMACOLOGY AND THERAPEUTICS. 

ness of the extremities. It is a well recognized fact, however, 
that the effects of cannabis indica may vary greatly in different 
persons. This difference of action is due largely to individual 
peculiarities and also in part, no doubt, to the varying strength 
of the preparations of the drug. In man the heart is generally 
accelerated when cannabis indica is inhaled. In animals it is 
said that its intravenous injection slows the heart, partly through 
inhibitory stimulation and partly through direct action on the 
cardiac muscle, and that this action on the heart is the cause 
of death after poisonous quantities. In them the general effects 
appear to resemble those met with in man and also to present 
the same marked variations. There is sometimes observed a 
stage of exaltation with increased movement, and this is fol- 
lowed by depression and sleep. In dogs and cats vomiting is 
a not infrequent symptom. In frogs the reflex excitability is 
found to be first augmented and then depressed. While the 
habitual use of the drug in large amount may lead to grave 
psychic disturbances, it does not appear to cause constipation 
and the same disturbance of digestion and nutrition as opium. 
Some writers, however, assert that while a single dose does not 
usually produce constipation, and may even have a slightly 
laxative effect, after long continued administration there is a 
tendency to constipation both in man and in dogs. Dryness of 
the mouth, thirst, nausea, vomiting and strangury are untoward 
effects occasionally seen. 

Therapeutics of Cannabis Indica. 
While the physiological effects of this agent constitute a 
very interesting study, it is not of any great therapeutic im- 
portance, since almost any indication that it might be supposed 
to fulfill can be more satisfactorily and certainly met by other 
remedies. As a cerebral depressant it has been employed in 
a considerable number of affections, and in many of them it has 
been entirely abandoned. As a hypnotic it is unreliable, and, 
according to some authors, it produces sleep in only about 50 
per cent, of the cases. In many instances there is excitement 



OPIUM. 843 

without sleep. It might be used, however, in certain instances 
in which opium is contra-indicated, and also as a substitute for 
opium in some mental diseases. As an analgesic it is some- 
times of service. It has been given with advantage in cases 
of migraine and neuralgia, although it not infrequently fails to 
afford relief. In biliary colic it also sometimes proves success- 
ful. Cannabis indica enters into the composition of the pro- 
prietary medicine known as chlorodyne {see p. 888) and vari- 
ous other similar preparations which are more or less used as 
anodynes and hypnotics and are sometimes of great service in 
bowel troubles. When prescribing the tincture, the resin from 
which is precipitated by the addition of water, it is necessary 
to employ mucilage to suspend it, while the taste is usually 
covered with spirit of chloroform. 

2. General cerebral depressants. 

OPIUM. 
OPIUM.— Opium. Dose, 0.100 gm. (100 milligm.) ; V/ 2 gr. 

OPII PUL VIS.— Powdered Opium. Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 

Preparations. 

1. Extractum Opii. — Extract of Opium. Dose, 0.030 gm. 
(30 milligm.) ; i/ 2 gr. 

2. Emplastrum Opii. — Opium Plaster. 

3. Trochisci Glycyrrhizae et Opii. — Troches of Glycyrrhiza 
and Opium. 

4. Vinum Opii. — Wine of Opium. Dose, 0.5 c.c; 8 TTL. 

5. Pilulae Opii. — Pills of Opium. Dose, 1 pill. 

6. Purvis Ipecacuanha et Opii. — Powder of Ipecac and 
Opium. (Dover's Powder.) Dose, 0.500 gm. (500 milligm.); 
71/2 gr. 

7. Acetum Opii. — Vinegar of Opium. (Black Drop.) Dose, 
0.5 c.c; 8 TTL. 

8. Tinctura Opii. — Tincture of Opium. (Laudanum.) Dose, 

0.5 c.c; 8 ni. 



844 PHARMACOLOGY AND THERAPEUTICS. 

9. Tinctura Opii Camphorata. — Camphorated Tincture of 
Opium. (Paragoric.) Dose, 8 C.C.; 2 fl. dr. 

10. Tinctura Ipecacuanhae et Opii. — Tincture of Ipecac and 
Opium. Dose, 0.5 c.c; 8 T\{. 

OPIUM GRANULATUM.— Granulated Opium. Dose, 0.065 gm. 
(65 milligm.); 1 gr. 

Preparations. 

1. Opium Deodoratum. — Deodorized Opium. Dose, 0.065 gm. 
(65 milligm.); 1 gr. 

2. Tinctura Opii Deodorati. — Tincture of Deodorized Opium. 
Dose, 0.5 c.c; 8 7H,. 

MORPHINA.— Morphine. Dose, 0.012 gm. (12 milligm.); $ gr. 

MORPHINE HYDROCHLORIDUM.— Morphine Hydrochloride. 
Dose, 0.015 gm. (15 milligm.) ; y 4 gr. 

MORPHINE ACETAS.— Morphine Acetate. Dose, 0.015 gm. (15 
milligm.); y 4 gr. 

MORPHINE SULPHAS.— Morphine Sulphate. Dose, 0.015 gm. 
(15 milligm.) ; y 4 gr. 

Preparation. 
Pulvis Morphinae Compositus. — Compound Powder of Mor- 
phine. Dose, 0.500 gm.; 7y 2 gr. 

Unofficial Preparations. 
Trochisci Morphinae et Ipecacuanhae (U. S. P., 1890). — 
Troches of Morphine and Ipecac. Dose, 1 to 5 troches. 

Liquor Morphinae Bimeconatis. — Solution of Morphine 
Bimeconate. Dose, .30 to 2.50 c.c; 5 to 40 nl. 

Acidum Meconicum. — Meconic Acid. 

Pilula Ipecacuanhae cum Scilla. — Pill of Ipecacuanha with 
Squill. Dose, .30 to .60 gm.; 5 to 10 gr. 

Tinctura Chloroformi et Morphinae Composita. — Compound 
Tincture of Chloroform and Morphine. Dose, .30 to .60 C.C. J 
5 to 10 TTL- 

Tinctura Opii Ammoniata. — Ammoniated Tincture of Opium. 
Dose, 2 to 4 c.c; y 2 to 1 fl. dr. 



OPIUM. 845 

Heroina. — Heroine. (Morphine Diacetic Ester.) Dose, .003 
to .012 gm.; ^ to i gr. 

Heroinae Hydrochloridum. — Heroine Hydrochloride. Dose, 
.003 to .012 gm.; & to I gr. 

Dionina. — Dionine. (Morphine Mono-ethyl Ester Hydrochlo- 
rate.) Dose, .01 to .015 gm.; 1 to i gr. 

Peronina. — Peronine. (Morphine Benzylic Ester Hydrochlo- 
rate.) Dose, .0004 gm.; yi^ gr. 

Action of Opium. 

The effects of opium being due almost entirely to its mor- 
phine, the action and therapeutics of the two may be studied 
together. Codeine and some other alkaloids are considered a 
little later on (see pp. 865 and 866). Meconic acid appears to 
be nearly free from physiological properties. 

External. — Though locally it has been said to possess feeble 
analgesic properties, opium probably has no action when applied 
to the unbroken skin ; but from mucous membranes and raw sur- 
faces it is absorbed, and it then exerts a marked anodyne in- 
fluence. The latter, however, is due to the central action of 
the drug, as the sensory nerve endings appear to be in no way 
affected by it. 

Internal. Secretions. — Most of the secretions are diminished 
by opium. The sweat, however, appears to be increased in 
consequence of dilatation of the cutaneous blood-vessels. 
Opium tends to check the secretion of saliva, but when nausea 
is caused, both the saliva and sweat are often markedly in- 
creased in consequence of this condition, rather than from any 
direct effect of the drug itself. It is noted also that in the 
last stages of opium poisoning the perspiration is sometimes 
profuse, but this is simply a result of the asphyxia. It is not 
known precisely what effect the drug has upon the bile or the 
pancreatic secretion. The urine is scarcely affected by it, 
though, in consequence of the absence of sphincter reflex, re- 
tention in the bladder not infrequently occurs. So far as 
known, all the other secretions are diminished. 



846 PHARMACOLOGY AND THERAPEUTICS. 

Alimentary Canal. — Unless the dose is very small, dryness 
of the mouth and a feeling of thirst are promptly caused. 
Whether administered by the mouth or not, opium tends to 
produce nausea and vomiting and to impair the digestion. The 
nausea and vomiting would seem to be probably due in part to 
peripheral and in part to central action. When morphine is 
given by subcutaneous injection, it is quickly excreted into the 
stomach, and yet the great rapidity with which vomiting fol- 
lows its administration in this way in dogs (in which this 
symptom is more constantly produced than in the human sub- 
ject) points to an action on the medullary centre. Small quan- 
tities of opium lessen the sensation of hunger, and this is be- 
lieved to be probably due rather to central action than to a 
local influence on the stomach. Because of the lessened per- 
ception of hunger and the gastric derangement, the appetite is 
diminished. In man and certain animals opium causes diminu- 
tion of intestinal peristalsis and constipation, in consequence, 
probably, of some peripheral action. Not only does it tend to 
check the movement of the bowels, but it abolishes or mitigates 
abdominal pain when present. Very large doses cause violent 
peristalsis and diarrhoea in the dog, cat and, according to some 
observers, the rabbit. 

Circulation. — Small doses have little or no effect upon the 
heart and circulation. With either large or small doses, how- 
ever, there may be some quickening of the pulse at first, in con- 
sequence of nausea. Large amounts cause slowing of the heart 
through primary stimulation of the vagus centre in the medulla, 
as well as by an action on the cardiac motor ganglia. At the 
same time, from some obscure central action, the cutaneous 
vessels dilate. This gives rise to a full pulse and to a sensa- 
tion of warmth in the skin, which may be followed by itching 
or discomfort, but has little influence on the general blood- 
pressure. The latter generally remains high, and the circula- 
tion is only greatly depressed quite late in the poisoning. While 
such depression is dependent to a considerable extent on vaso- 
motor paralysis, it is no doubt largely secondary to respiratory 



OPIUM. 847 

failure. The heart finally stops in diastole, but death is rarely 
due to the effects of the poison on this organ or its nervous 
apparatus. 

Respiration. — The respiration is slowed and at first deepened, 
but the increased depth is not sufficient to counterbalance the 
slowness of the breathing, so that the air inspired per minute 
is reduced. Later the respirations become not only shallow 
but irregular, and may assume the Cheyne-Stokes type. Pa- 
ralysis of the respiratory centre, to which opium acts as a 
direct poison, is the ordinary cause of death. The bronchial 
mucus, like the secretions in general, is diminished by opium. 

Nervous System. Brain. — The action on the cerebrum con- 
sists for the most part of a depression of the higher functions. 
In man, owing to the greater development of the brain, the 
narcotic effect of the drug is much more pronounced than in 
other animals. The depression is usually preceded by a stage 
of excitement, characterized by restlessness and increased men- 
tal activity, the length of which varies greatly in different indi- 
viduals; but in some instances this appears to be entirely lack- 
ing. As a rule, it is found that the period of excitation can be 
maintained for a considerably longer time by the administration 
of small doses at frequent intervals, while under the effect of 
a single large dose it is short or absent, and deep sleep very 
soon comes on. During this first stage the imagination is often 
stimulated, the fancy has free play, and the creative powers are 
augmented, while the attention, judgment, coordination of the 
brain, and reasoning faculties are less keen than ordinarily. 
In exceptional instances, however, the intellectual power and 
mental vigor are increased. The general effect seems to be 
that of a series of stimulations and depressions going on at the 
same time, but whether these successively involve the same or 
different centres is unknown. Different parts of the brain 
appear to be affected in different degrees and at different inter- 
vals of time, so that, as held by some, these act in a dissociated 
manner and more or less independently of each other. It is 
well recognized that the symptoms are greatly influenced by 



848 PHARMACOLOGY AND THERAPEUTICS. 

individual susceptibility and by race, and among Oriental peo- 
ples the stage of excitement is generally much more prolonged 
than in Europeans. The motor areas of the brain are affected 
much more markedly in some animals than in man, and dogs, 
in which there is often noted a paralysis of the hind legs, are 
said to always exhibit a clumsiness in their voluntary move- 
ments which closely resembles that observed after ablation of 
these areas. In man it is often difficult to detect any evidence 
of stimulation of the cerebral motor centres, but the depres- 
sion of these is never so pronounced as that of the intellectual 
faculties. It is true that the patient, in consequence of the 
debility and muscular weakness present, seeks a recumbent 
posture, but he can be walked about if he is supported. He feels 
in a most contented frame of mind, and sooner or later sinks 
into a sleep which is generally filled with dreams, often of the 
most fantastical character, though in some individuals it is en- 
tirely free from dreams. If the dose is large, the slumber is 
more apt to be dreamless. If it is not a poisonous one, the 
patient can be easily aroused, but under toxic amounts he soon 
sinks into complete coma. Opium is not only a powerful hyp- 
notic, but the most perfect analgesic known. The dose required 
in any given case to annul pain naturally depends largely upon 
the severity of it. After small doses of the drug patients gener- 
ally awake refreshed, though not infrequently there is a little 
languor, dryness of the throat, headache, and possibly nausea. 
In some instances the headache is quite severe and accompanied 
by nausea, vomiting and depression. 

Medulla Oblongata and Spinal Cord. — The principal effect 
in the medulla is the profound depression of the respiratory 
centre. The other centres are much less affected, and in cases 
of fatal poisoning this is paralyzed before the centres of car- 
diac inhibition* and vaso-constriction are depressed to any 
marked extent. There is, however, a distinct depression of the 
vomiting centre, so that, although vomiting may perhaps be at 
first induced by its transient irritation, emetics do not act well 
in opium poisoning. In man the spinal cord is but little af-^ 



OPIUM. 849 

fected except by large amounts. Mostly there is depression of 
its conducting and reflex functions, but in a few instances, after 
large doses, there have been observed increase of reflex excita- 
bility and twitchings or convulsions of spinal origin. In some 
of the higher animals there may be evidences of a similar action 
on the cord, but for the most part in mammals, after poisonous 
doses, the failure of the respiration closes the course of the 
intoxication. In the cold-blooded animals, however, there is 
found to follow a further development of excessive reflex irri- 
tability, which may pass into tetanic spasm. In the frog this 
reflex action is first diminished to a slight extent, and then 
increased to the same degree as by strychnine. In man opium 
sometimes has an aphrodisiac influence, and this has been at- 
tributed in part to stimulation of the cord and in part to the 
effect on the imagination. 

Nerves and Muscles. — Except when given in enormous doses, 
the drug has no effect upon the peripheral muscles and nerves. 
Even when directly applied to the nerve, it has been found to 
have little influence on its irritability. Practically, therefore, 
opium has no action upon nerve fibres or endings. While in 
the frog the subcutaneous injection of large amounts of mor- 
phine may diminish the power of the end-organs to transmit 
impulses, this is not the case in mammals. In them the sensi- 
bility of the skin is lessened by an injection, but this appears 
to be a result of central action, since no more effect is produced 
at the point of application than elsewhere. In its general effect 
upon the nervous system opium affords a good example of the 
law of dissolution (see p. 737). 

Pupil. — One of the characteristic effects of the drug is con- 
traction of the pupil, and this is undoubtedly a central and not 
a peripheral action, since it does not occur after local applica- 
tion, nor after division of the nerve-trunks going to the iris. 
It is at once overcome by the application of atropine to the 
conjunctiva. After large doses of opium the pupil is reduced 
to the size of a pin-head, but in fatal poisoning it often becomes 
widely dilated shortly before death, as a result of the asphyxia. 
55 



85O PHARMACOLOGY AND THERAPEUTICS. 

In birds, which are not much more tolerant of morphine, when 
given subcutaneously, than most mammalian animals, the pupil 
remains unaffected. In animals in which the drug causes move- 
ment and excitement, such as the cat tribe, it is widely dilated, 
while in some other animals, such as dogs and rabbits, it is 
affected in much the same way as in man. 

Temperature. — Sometimes opium causes a slight preliminary 
rise of temperature. In most instances it occasions an incon- 
siderable fall, which is probably attributable to the lessened 
movement, as well as the dilatation of the cutaneous blood- 
vessels. Experiments on animals indicate that the heat centre 
in the brain is rendered less sensitive by the drug. 

Skin. — As has been seen, opium causes some increased secre- 
tion of sweat, though its diaphoretic property is not usually very 
marked. As the effects of the drug are passing off, redness and 
itching of the skin are sometimes observed, and in susceptible 
individuals the erythema may lead to exanthemata, such as an 
eruption of small red spots resembling roseola. 

Metabolism. — The metabolism is ordinarily lessened as a 
result of the quiet condition of the subject caused by the drug, 
so that the excretion of carbon dioxide is diminished in conse- 
quence of the depression; but in animals like the cat, in which 
great excitement is caused, its output is increased from the 
augmented muscular movement. There is also a lessened ex- 
cretion of nitrogen. In consequence of the impairment of res- 
piration, there may be an increase in the lactic acid of the 
blood and urine, and glycosuria may be present, while glycogen 
may disappear from the liver. In patients suffering from dia- 
betes the amount of sugar in the urine is diminished. Tran- 
sient albuminuria may occur after opium, and it has been sug- 
gested that this may possibly be due to vaso-motor changes 
affecting the circulation of the kidney. In chronic morphinism 
also there is diminished metabolism, but this is probably attrib- 
utable for the most part to the derangement of digestion. 

Excretion. — Opium is excreted chiefly by the digestive tract, 
in the salivary, gastric and intestinal secretions, and is found 



OPIUM. 85I 

in large amount in the faeces. As morphine has been detected 
in the stomach in 2 T / 2 minutes after the subcutaneous injection 
of .03 gm. ( J / 2 gr.), there appears no question that the drug 
is capable of reabsorption from the gastro-intestinal tract. 
Traces of the drug have been found in the urine, but only after 
large doses. It is thought that a certain amount of it may 
perhaps undergo partial oxidation in the tissues, since oxida- 
tion products, such as oxydimorphine, have been observed in 
the urine. It is also excreted to some extent in the milk of 
nursing women, so that it may cause morphinism in the child. 
The substances which produce the characteristic odor of opium 
are excreted largely by the urine and less freely by the breath, 
sweat and milk. 

Peculiarities. — Reference has already been made to the 
marked differences in the effects of opium in different indi- 
viduals. In some instances, instead of having a soothing in- 
fluence and putting the patient to sleep, it produces sleepless- 
ness and excitement, which may amount to delirium. In others 
it causes marked nausea and vomiting, gastric pain, and indi- 
gestion, often with very severe headache. Some of these bad 
effects may very likely be due to the varying composition of 
the drug, but certain individuals present such a pronounced 
idiosyncrasy against opium that it cannot be administered to 
them in any form without very unpleasant results. Children 
are much more susceptible to its influence than adults, so that 
it must always be given to them with great caution, and women 
are, as a rule, more easily affected by it than men. Among the 
other untoward effects of opium may be mentioned diarrhoea, 
dyspnoea, aphrodisia, fever and hyperidrosis. Its effect in some- 
times causing skin eruptions has been previously mentioned. 
The tolerance of the drug by the system is remarkable, so that 
persons who use it habitually are soon able to take enormous 
quantities with impunity, so far as any immediate danger to 
life is concerned. The explanation of the tolerance is believed 
to be the increased power of the organism to destroy the poison. 

Differences in Action between Opium and Morphine. — A 



852 PHARMACOLOGY AND THERAPEUTICS. 

number of differences have been noted in the effects of mor- 
phine and opium. These are as follows: (1) Morphine is 
absorbed more rapidly, and hence acts more quickly. It is 
therefore especially adapted for subcutaneous injection, and, 
administered in this way, it produces its effects with great 
promptness. (2) Opium is more apt to interfere with the 
digestion, although it is claimed by some that it causes less 
nausea than morphine. (3) Opium is more liable to cause con- 
stipation. This is both on account of the greater local action 
of crude drugs as compared with alkaloids, and because it re- 
mains in the intestine for a longer time than morphine. Con- 
sequently, it produces a more pronounced effect there than else- 
where in the economy, and this fact is availed of in the treat- 
ment of many abdominal diseases. (4) Opium has greater 
diaphoretic properties. (5) Morphine is more certain, as well 
as more rapid, in its anodyne and hypnotic effects. (6) Mor- 
phine is less convulsant. (7) Opium is thought to have a 
stronger effect in reducing the sugar in the urine when glyco- 
suria is present. (8) Opium affects the bladder sphincter less. 
(9) Morphine causes more pruritus. (10) Morphine is ex- 
creted more readily. 

Therapeutics of Opium. 
External. — Local applications of opium to relieve pain have 
long been in common use and are still often employed, but as 
it has been clearly shown that the drug has no effect on sen- 
sory nerve terminations, the practice must be regarded as sim- 
ply a concession to a deeply-rooted popular sentiment, which 
has been handed down from the past. The apparent good 
results obtained are no doubt due for the most part to the 
absorption of the drug from wounds or mucous surfaces. 
When it is applied to the unbroken skin, there is either no 
benefit, or else such relief as is afforded is attributable to adven- 
titious circumstances. Thus, it must be due to the heat, and 
not to the opium, when hot fomentations or poultices sprinkled 
with laudanum (a very common application) are employed. 



OPIUM. 853 

So, while Linimentum Opii (B. P., tincture of opium and soap 
liniment, equal parts), rubbed into the skin, may be of service 
in chronic rheumatism, neuralgia, etc., it is probably the fric- 
tion that is the principal factor in relieving the pain. The most 
popular form of this external use is the lead and opium wash, 
and the probable explanation of its undoubted efficacy in 
sprains, contusions and other painful conditions is to be found 
in the non-irritating covering furnished by the lead precipitate 
and the astringent action of the lead itself. The ointment of 
nutgall and opium (B. P., powdered opium, 2; gall ointment, 
27) is much used to relieve the pain of haemorrhoids and anal 
fissures. The warm decoction of the white poppy is used in 
England as an anodyne fomentation. Poppy capsules (Papav- 
eris Capsular, B. P.) are obtained from the Papaver somnif- 
erum, which is cultivated in England. A ten per cent, decoc- 
tion made from these contains but a small and uncertain amount 
of opium, and its beneficial effects, if any, are doubtless due 
to its warmth. 

Internal. G astro -intestinal Tract. — Morphine, which is here 
preferable to opium, is of much value in relieving the pain of 
organic disease of the stomach (ulcer and cancer), as well as 
of irritative dyspepsia. It may be given in solution (morphine, 
1; water, 480; dose, 4 c.c. ; 1 fl. dr.), and it is also much used 
in combination with bismuth, zinc and silver salts in painful 
stomach diseases. Opium is often of great service in acute 
gastritis, and it is advised that it should always be given in 
liquid form, preferably as the Tinctura Opii Deodorati. Many 
forms of vomiting, whether of peripheral or reflex origin, are 
checked by morphine, and it is likely to prove useful after the 
stomach has been emptied in cases of vomiting caused by irri- 
tant matters. In colic, and especially lead colic, it often re- 
lieves the pain without increasing the constipation; while 
allaying the spasm of the intestine, it does not appear to entirely 
stop its peristalsis. In diarrhceal diseases opium is of the 
greatest possible value, but it must be used with discrimination 
and judgment. In acute diarrhoea due to irritating kinds of 



854 PHARMACOLOGY AND THERAPEUTICS. 

food and in mucous diarrhoea it is advisable that before using 
it the bowel should be cleared by a purgative. When the evacu- 
ations are watery, it may be combined with advantage with lead 
acetate or a mineral acid. In acute dysentery it is generally 
most efficacious after the preliminary administration of mag- 
nesium sulphate or other saline. It is frequently given by the 
rectum either in an enema with starch or milk or in supposi- 
tory. In chronic dysentery it is the most reliable remedy, and 
may be employed in association with the salts of zinc, silver, 
copper or arsenic. In malarial dysentery, particularly, Patna 
opium, which contains over 6 per cent, of anarcotine, an anti- 
periodic, is especially indicated in combination with arsenic. 
In cholera morbus the hypodermatic injection of morphine is 
of great service, but in cholera infantum any form of opium 
must be used with great caution on account of the danger of 
producing narcosis. In cholera it is useless in the stage of 
collapse, but may prove of benefit in the preliminary diarrhoea, 
and it is an important ingredient of the various so-called cholera 
mixtures. In intestinal colic and abdominal pain of whatever 
origin opium generally affords relief, and it is largely used in 
the treatment of peritonitis and other inflammations and after 
operations or wounds of the abdomen. In severe abdominal 
cases it has been customary to push the drug to decided narco- 
sis, without paying any attention to the constipation caused, 
but the more recent and better practice is to keep the bowels 
slightly open by the use of salines. When the full-dose opium 
treatment is employed in peritonitis, so that the paralyzing of 
the intestinal movements prevents the peritoneal surfaces from 
rubbing against each other, extensive adhesions are quite likely 
to result. As mercury is regarded by many as of special value 
in modifying inflammations of the serous membranes, particu- 
larly if combined with opium, it is a common practice to give 
calomel along with the opium, at least for a time. The follow- 
ing general caution has been suggested as one of great prac- 
tical importance: As a rule, opium does harm in all gastro- 
intestinal affections in which there is a deficiency in the proper 



OPIUM. 855 

secretion, or a suspension of the functions, of the liver and 
kidneys. At the same time, the hypodermatic injection of mor- 
phine, by the action of the drug in relaxing spasm, is invaluable 
for the relief of the agonizing pain accompanying the passage 
of biliary and renal calculi, and is also of service in control- 
ling the vomiting which is often present. 

Heart. — It is quite probable that in small doses administered 
hypodermatically morphine is a cardiac stimulant. At all 
events, it often acts very happily in the pain and distress caused 
by disease of the heart, and its cautious subcutaneous injection 
may be tried in all forms of cardiac dyspnoea. It is especially 
indicated in those cases in which the patient, while perhaps 
able to breathe quite easily when awake, suffers from marked 
distress as soon as he falls asleep. Opium or morphine given 
by the mouth are usually much less efficient in affording relief 
in heart-trouble than morphine administered in this manner. 
The pain of aortic aneurism and intra-thoracic growths, like 
pain in general, is relieved by morphine. It is quite customary 
to give the drug in association with small doses of atropine, as 
it is found that its analgesic effect is rather increased than 
diminished thereby, while the sleep resulting is less disturbed 
and more nearly approaches normal sleep. In addition, the 
atropine serves to counteract some of the depressing effects 
upon the heart and respiration and also to largely prevent sub- 
sequent headache, vertigo and nausea, as well as constipation. 
It has been shown that in the use of chloroform for anaesthetic 
purposes a hypodermatic injection of morphine just before the 
inhalation begins prolongs the stage of narcosis with a less 
quantity of chloroform, diminishes the danger of cardiac paraly- 
sis, and tends to prevent the after-nausea and depression. The 
same is true as regards other anaesthetics, and especially in the 
case of persons addicted to alcoholic stimulants and of excep- 
tionally neurotic patients does the preliminary morphine injec- 
tion render the anaesthetization safer and favorably affect the 
stage of recovery. 



856 PHARMACOLOGY AND THERAPEUTICS. 

Vessels. — Although not acting directly upon the vessels or 
blood, opium is most valuable as an internal haemostatic. This 
effect is largely in consequence of the quietude secured by it, 
which allows the blood to coagulate in ruptured vessels. When, 
as is frequently the case, the haemorrhage is attended by marked 
restlessness, the drug is absolutely indicated because of its 
sedative effect both on mind and body. It is especially effica- 
cious in gastric and intestinal haemorrhage, where its influence 
in diminishing peristalsis is of material service, and also in 
pulmonary haemorrhage. In haematemesis and haemoptysis the 
benefit derived from it is in no small measure due to its con- 
trolling of vomiting and coughing, both of which are apt to 
bring on fresh bleeding. A very good preparation to use is 
the Pilula Plumbi Cum Opio (B. P., powdered opium, 1; lead 
acetate, 6; dose, .12 to .25 gm. ; 2 to 4 gr.). Hypodermatic 
injections of morphine are preferred by some, and when these 
are used they should be repeated at regular intervals as long 
as further haemorrhage or the risk of it continues. 

Respiration. — Opium, on account of its depressant effect upon 
the medullary centre, must be given with caution in respiratory 
diseases, but in well selected cases it is of marked benefit. An 
incipient catarrh may often be aborted by a full dose of Dover's 
powder. In bronchitis with excessive secretion very small 
amounts of opium may be sufficient to diminish its amount, as 
well as allay cough. If, however, the secretion is scanty and 
tenacious and expectoration difficult, opium may aggravate 
rather than relieve the condition. In pleurisy and pneumonia 
it is often of great service in controlling cough and relieving 
pain, but the tendency to asphyxia in serious diseases attended 
with cough must always be borne in mind. Opium should 
therefore never be used in the last stages of pneumonia and 
bronchitis. By its antispasmodic properties it is frequently 
efficient in arresting the symptom asthma, but its use here is 
objectionable on account of the danger of inducing the opium 
habit. It is a very frequent and useful ingredient of expec- 
torant mixtures, and among the preparations commonly em- 



OPIUM. 857 

ployed in the treatment of cough are paregoric, Dover's powder, 
compound liquorice mixture, the ammoniated tincture (B. P.), 
the pills of ipecacuanha and squill (B. P.) the compound mor- 
phine powder, and the compound tincture of chloroform and 
morphine (B. P.). Codeine is preferable to all other prepara- 
tions and alkaloids of opium for relief of cough in pulmonary 
diseases. Heroine is also very much used for this purpose at 
the present day. To relieve the pain of tubercular or other 
organic disease of the larynx an insufflation may be used con- 
sisting of morphine acetate, .06 gm. (1 gr.) and .30 gm. (5 gr.) 
of starch, with or without .06 gm. (1 gr.) of iodoform or 
boric acid. As the morphine produces its action only after 
absorption, however, other agents have a more prompt and 
efficient local anaesthetic effect. The intra-laryngeal applica- 
tion of menthol and orthoform constitutes one of the best means 
of affording relief in these cases. 

Nervous System. — Opium is unrivalled in its influence in 
relieving pain from whatever source and in inducing sleep when 
insomnia is due to pain. For these purposes the hypodermatic 
injection of morphine is usually preferred, as acting more 
promptly and certainly and less liable to cause nausea - or diges- 
tive disturbances than opium or morphine given by the mouth, 
and atropine sulphate is often added to the solution in- 
jected for the purpose of minimizing as far as possible any 
ill-effects of the morphine salt. Morphine is of great value 
in relieving the after-pains of labor, and may be of ser- 
vice in spasm of the bladder sphincter and spasmodic stricture 
of the urethra by its action in relaxing the muscular contrac- 
tion. It is manifestly impossible to more than hint at the al- 
most unnumbered applications of opium or morphine as an 
analgesic and hypnotic, but it is obvious that its use should as 
a rule be restricted to acute or rarely recurring conditions, on 
account of the very great danger of the patient's contracting 
the opium habit. For the relief of pain and insomnia in in- 
curable diseases, however, the judicious employment of the 
drug for an indefinite period is entirely justifiable. Enormous 



858 PHARMACOLOGY AND THERAPEUTICS. 

doses are often borne by patients suffering from very severe 
pain without the development of any indications of poisoning. 
Morphine is sometimes an efficient sedative in delirium tremens 
and other forms of mania, but not infrequently such large quan- 
tities are required as to render it an unsafe remedy. In acute 
mania small doses are said to be the most efficient if the arterial 
tension is low, but if the pulse is quick and the blood-pressure 
high, the full effect of the drug is necessary. Large hypoder- 
matic doses require the utmost circumspection, especially in 
obese and aged subjects. In delirium tremens chloral is usually 
a more satisfactory hypnotic than morphine. In melancholia 
excellent results have been claimed from the use of opium in 
small or stimulant doses, and here the best form for its admin- 
istration is the tincture. There is reason to believe that the 
hypodermatic injection of morphine is of great value in many 
cases of puerperal eclampsia, and its use appears to be growing 
in favor. It has also been advocated for the relief of ursemic 
convulsions when due to acute nephritis, whether puerperal or 
not, on the ground that it tends to arrest muscular spasms by 
counteracting the effect of the poison on the nerve-centres, to 
establish profuse diaphoresis, and to facilitate the action of 
cathartics and diuretics. In hysteria it is not as efficient as 
various other remedies, and is especially objectionable from 
the risk of its inducing the opium habit. In arachnitis, pachy- 
meningitis and basilar meningitis opiates in small doses seem 
to accomplish more than other remedies, and the hypodermatic 
injection of morphine in quantities sufficient to relieve the 
pain and rigidity is considered of value in the earlier 
stages of cerebro-spinal meningitis. When effusion has taken 
place and stupor and coma supervene, opiates are no 
longer of use. In conditions of increased excitability, such as 
tetanus, strychnine poisoning, and epilepsy, opium has been 
found on the whole to be harmful rather than beneficial. Still, 
in a large number of affections it is one of the most efficient 
of all remedies for relieving spasm, and its admirable action 
in this capacity has been incidentally referred to in several 



OPIUM. 859 

classes of cases. It may be mentioned here that severe hic- 
cough is very commonly arrested by a hypodermatic injection 
of morphine. As opiates are as completely absorbed from the 
rectum (if the latter be thoroughly cleared) as from the stom- 
ach, it is often advantageous to administer them in enemata or 
suppositories. Since the absorption is slower, however, the dose 
should be twice or possibly three times as large as when they 
are given by the mouth. In surgical practice opium has always 
been widely used to prevent or mitigate shock, as well as to 
relieve pain and check or alleviate inflammation. Its uses in 
surgery can only be briefly referred to in passing, but there 
seems to be no question that it not only relieves existing 
shock, but is a potent factor in the prevention of secondary 
shock. It is the first remedy called for when pain or haemorrhage 
is present, and the hypodermatic injection of morphine is strongly 
indicated in shock following injury, especially if an operation 
is required. It is an inestimable boon in severe burns, and it 
is particularly indicated in fractures, where it not only allays 
the immediate pain, but brings about muscular relaxation and 
relieves many distressing symptoms. It is not uncommon now 
to hear surgeons decrying the use of opium under almost any 
circumstances, but while its careless and unscientific employ- 
ment has brought this powerful therapeutic agent into more 
or less disrepute, there can be no doubt that it will still con- 
tinue to occupy the highest position in the estimation of those 
who use it judiciously, 

Kidneys. — It is probable that the feeling which has existed 
against the use of opium when Bright's disease is present has 
been due to the idea that the impaired state of the kidneys pre- 
vents the proper elimination of the drug; but since it has been 
conclusively shown that only the faintest traces, if any, are nor- 
mally excreted by these organs, it would seem, from a theoret- 
ical point of view at all events, that there is less risk in its 
employment in this class of cases than has generally been sup- 
posed. As a matter of fact, however, several instances of 
chronic nephritis are on record in which death was apparently 



860 PHARMACOLOGY AND THERAPEUTICS. 

caused by quite small doses of opium. It is the part of pru- 
dence, therefore, to use it with great caution in cases of chronic 
Bright's disease. Still, ample justification is afforded for its 
judicious employment, notwithstanding the apparent risk, by 
the marked relief which often attends the hypodermatic injec- 
tion of small amounts of morphine in the uraemic dyspnoea, 
uraemic insomnia, and cardiac dyspnoea so likely to be met with 
in the course of this affection. Its employment in uraemic con- 
vulsions has already been referred to as limited to cases due 
to acute nephritis. 

Skin. — Dover's powder is of considerable utility as a dia- 
phoretic. It is commonly given in acute muscular rheumatism, 
and at the onset of " colds " and febrile attacks of various 
kinds, and will often effect a cure, particularly if its action is 
aided by hot drinks and a hot foot-bath. 

Metabolism. — Opium and its derivatives are acknowledged to - 
have a favorable effect in many cases of diabetes, not only 
materially diminishing the amount of sugar in the urine, but 
also often causing an amelioration in the general condition of 
the patient. Codeine is undoubtedly the most serviceable form 
in which to employ the drug in this disease. Opium has ap- 
parently a beneficial influence, the precise nature of which is 
not very clear, in all sorts of inflammations, and it is thought 
to be particularly efficacious in those of the serous membranes. 

Heroine (not official) is morphine diacetic ester, which as a 
hydrochloride is freely soluble in water and alcohol. It gen- 
erally produces no disagreeable symptoms, beyond headache, 
and is stated not to give rise to habituation. A more extended 
knowledge of the drug, however, would seem to indicate that 
the latter assertion is not entirely correct. It occasionally pro- 
duces violent and uncontrollable vomiting. Since it diminishes 
the sensitiveness of the respiratory centres to an excess of car- 
bon dioxide in the blood, it is useful in some forms of dysp- 
noea. It is of great value in quieting cough. 

Dionine (not official) is morphine mono-ethyl ester hydro- 
chlorate, which is readily soluble in water. It is somewhat 



opium. 861 

hypnotic, and like heroine is useful to allay cough. It is said 
to check night sweats. 

Peronine (not official) is morphine benzylic ester hydro- 
chlorate, soluble in water. This is .hypnotic, producing sound 
sleep without previous excitement, and is useful in allaying the 
cough of pulmonary tuberculosis, chronic bronchitis and pertus- 
sis. 

TOXICOLOGY. 

Acute . Poisoning. — The symptoms usually appear in from ten 
minutes to one hour after opium has been taken by the mouth. As 
might be expected from the effects of the drug upon the central nervous 
system, they are those of profound narcotism. Drowsiness may or may 
not be preceded by some slight excitation, and as a rule it supervenes 
very quickly. The drowsiness passes into sleep, from which the patient 
may be roused, but soon this deepens into stupor and eventually into 
complete coma, in which reflex excitability is abolished and no stimula- 
tion of any kind has the slightest effect. A characteristic phenomenon is 
the extreme contraction of the pupils. The countenance, at first flushed, 
becomes pale and then cyanotic, while the lips are livid. The general 
surface is cold, and as the poisoning advances becomes bathed with 
prespiration. In the earlier stages the pulse is apt to be full, slow and 
laboring : later it becomes so weak as to be almost imperceptible. The 
breathing gradually grows slower and more stertorous, as well as irregu- 
lar. The limbs are relaxed, but death, which, as mentioned, is due to 
respiratory failure, may possibly be preceded by asphyxial convulsions. 
The fatal result may occur in from two to ten hours. Even when coma 
and convulsions have developed, recovery is possible, and in that case 
the coma passes into a condition of slumber which not infrequently lasts 
for from twenty-four to thirty-six hours. The patient is then apt to 
suffer from much nausea, headache and nervousness. 

Diagnosis of Poisoning by Opium. — (i) From Alcoholic Poisoning. — 
This is often very difficult, especially when the patient has taken alcoholic 
stimulus, and it is important that a correct history of the case should be 
obtained, if possible. Points of difference are that in opium poisoning 
the pupils are more minutely contracted and the patient can be roused 
with less difficulty. The breath usually has a characteristic odor after 
opium (though not after morphine), but this may be obscured by the 
smell of alcohol if this has been taken. An examination of the urine 
may perhaps be of service in determining the true condition present. 
(2) From Cerebral Hemorrhage. — If the pupils are unequally dilated, 



862 PHARMACOLOGY AND THERAPEUTICS. 

cerebral haemorrhage is present. If such haemorrhage has its site in the 
pons Varolii, the resultant contraction of the pupils may render the 
differential diagnosis very difficult, and local paralysis should be care- 
fully looked for. When hemiplegia is present, the recognition of cere- 
bral haemorrhage is easy. With a small haemorrhage, and especially in 
the pons, the temperature may be elevated, while with a large one, this 
is lowered for the first few hours, though it may rise afterwards. (3) 
From Phenol Poisoning. — While here there may be coma and con- 
traction of the pupils, the characteristic odor of the acid is present 
and its caustic effects may be observed upon the mucous membrane of 
the mouth. The urine is dark and smoky, and gives little of no pre- 
cipitate with barium chloride. (4) From Chloroform and Ether Poison- 
ing. — The smell of the breath and of the matters vomited will be a 
sufficient indication that the coma is due to one of these drugs." (5) 
From Uremia. — In uraemia the presence of albuminuria, even if no 
other sign of Bright's disease can be detected, will show the nature of 
the case. The odor of the breath is also characteristic in uraemia. (6) 
From Diabetic Coma. — Here the odor of the breath is likewise character- 
istic, and sugar will be found in the urine. (7) From the Comatose 
Stage of an Epileptic or other Fit. — In this condition the lividity of the 
face does not become progressively more marked, and the pupils are as 
a rule dilated. The history of the case, if obtainable, is also of service. 

Post-mortem. — The appearances are simply those characteristic of 
asphyxia. If death is due to opium, and not its alkaloids, the odor of 
the drug may be detected. The condition of the pupils varies in 
different instances. The gastric mucous membrane is sometimes found 
to be reddened. 

Treatment. — The stomach should be washed out, not merely once, but 
repeatedly and at short intervals, because the morphine which has been 
absorbed is excreted into the stomach. On this account the evacuation 
of the latter is called for whether the drug has been taken subcutaneously 
or not. Prompt emetics {see p. 175) should also be given, and especially 
apomorphine hydrochloride hypodermatically. If narcosis has already 
set in, however, the action of emetics may be materially interfered with. 
Potassium permanganate, well diluted, has been successfully used in an 
amount equal to that of the alkaloid ingested ; it almost immediately 
destroys the latter, through its chemical action. It is claimed that it 
can act upon the poison when in the blood, so that a hypodermatic injec- 
tion of it even for some hours after its ingestion * may afford relief. 
This has been denied, however, and it would seem probable that it is 
efficient only on that part of the poison present in the stomach. The 



OPIUM. 863 

reports have been so generally favorable that potassium permanganate 
should be used immediately. It has been recommended that atropine 
sulphate (.003 gm. ; ^ gr.) should be given hypodermatically, or tincture 
of belladonna (2 c.c. ; 30 TTL) by the mouth, and repeated every fifteen 
minutes ; but great caution must be exercised with the use of this anti- 
dote — if, indeed, it should be employed at all. Instances of recovery 
from opium poisoning followed by death from the belladonna or atropine 
given as an antidote have been observed. Some advise that .006 gm. 
(yL gr.) of atropine sulphate should be given as soon as possible, and 
not repeated. Caffeine, especially in the form of strong, black, hot 
coffee, is one of the best antidotes, and given in this way the tannin is 
also useful. Coffee may be administered by the mouth, and an enema 
of it (500 c.c. ; 1 pint) should also be given. Every effort should be 
made to rouse the patient and keep him awake, especially by walking 
him about, as the constant movement contributes to the better tone of 
the medullary centre. Flapping with a towel, pinching, etc., may also be 
restored to, as well as such general reflex stimulants as the application 
of the faradic current, cold affusions, the inhalation of ammonia, and 
the hypodermatic injection of ether. The patient should be kept warm, 
and artificial respiration may be called for. Oxygen or amyl nitrite 
inhalations are sometimes of service. The treatment must be kept up 
for several hours, of necessary. 

Chronic Opium Poisoning. — Chronic poisoning is, unfortunately, 
quite common, opium (usually in the form of laudanum or pills) being 
taken habitually by the mouth, or morphine by hypodermatic injection. 
The effects of the prolonged use of the drug, mental, moral and physical, 
are most deplorable. The symptoms, however, are more or less indefi- 
nite, and some individuals appear to continue the habit for many years 
with comparative immunity. Usually the patient loses weight, becomes 
anaemic, and suffers from loss of appetite and indigestion. The bowels 
may be continuously constipated, or constipation may alternate with 
diarrhoea. The pupils are contracted, the skin and tongue dry, and the 
nails brittle, while the hair turns prematurely gray and falls out. The 
heart is apt to be irregular, and muscular tremors and unsteadiness of 
gait are often observed. The patient is nervous, lacking in energy and 
will-power, and entirely unfit for work of any kind. He is utterly un- 
trustworthy in his statements, and becomes lost to all sense of honor 
and uprightness ; lying in the most bare-faced manner and even com- 
mitting theft, if necessary, in his endeavors to obtain the drug. Sexual 
impotence is a common result, and melancholia and dementia may 
eventually supervene, especially when morphine is used. In morphine 



864 PHARMACOLOGY AND THERAPEUTICS. 

habitues the arm, leg, or front of the body will usually be found to be 
scarred with marks of the needle. The craving for the drug is so 
intense that the patient suffers agonies when temporarily deprived of it, 
and it becomes necessary for him to increase the dose from time to time 
in order to secure the desired effect. The daily quantity of morphine 
used is thus often exceedingly large. The practice of opium smoking, 
the method of employment in vogue among Oriental peoples, appears 
to be less harmful in its results than the prolonged use of opium by the 
mouth or morphine by subcutaneous injection. 

Treatment. — The treatment of chronic poisoning is attended with 
immense difficulties, especially on account of the degraded moral con- 
dition of the habitue, and is very often unsuccessful in effecting a cure. 
As a rule, the patient should be isolated, and watched with the greatest 
vigilance to prevent his securing the drug surreptitiously. The morphine 
must not be withdrawn suddenly, as this is likely to be attended by 
collapse and aggravated mental disturbance, but the dose should be 
gradually diminished until it is deemed judicious to stop it altogether. 
There is no known drug which seems to have any curative effect, and 
the results of substituting agents such as cocaine for morphine have 
always proved disastrous. No reliance can be placed upon any of the 
advertised cures for the morphine habit ; most contain morphine and 
the remainder are useless. The patient on entering an institution for 
his cure must be most thoroughly and carefully searched so that he 
shall not be possessed of a supply sufficient to keep him comfortable 
during his treatment. 

Atropine. — Atropine {see p. 803) is a valuable antidote to morphine, 
especially from the fact that it powerfully stimulates the respiratory 
centre, and also because it tends to antagonize the depressing effects 
of this drug upon the cerebrum and upon intestinal peristalsis. At 
the same time, as mentioned above, the danger of substituting bella- 
donna for opium poisoning must always be borne in mind. While 
appearing to be antagonistic in some other respects, this is really not 
the case. Thus, although it arrests perspiration and dilates the pupil, 
it produces these effects by its action on the peripheral nerve termina- 
tions, while the opposite effects caused by morphine are due to action 
on the central nervous system. Still, it is found that in giving 
morphine by hypodermatic injection, certain of its disadvantages, 
such as indigestion, constipation and cardiac depression may be pre- 
vented or rendered less marked by combining atropine sulphate (.0004 to 
.0006 gm. ; T i^ to T ^gr.) with each dose. 



CODEINE. 865 

CODEINA.— Codeine. (Methyl Morphine.) Dose, 0.030 gm. (30 
milligm.); y 2 gr. 

CODEINJE PHOSPHAS.— Codeine Phosphate. Dose, 0.030 gm. 
(30 milligm.) ; y 2 gr. 

CODEINE SULPHAS.— Codeine Sulphate. Dose, 0.030 gm. (30 
milligm.); y 2 gr. 

Action of Codeine. 
Codeine is much less toxic than morphine, which it some- 
what resembles in the general character of its action. While it 
is powerfully analgesic, however, its hypnotic influence is quite 
limited. Small doses induce light sleep, but somewhat larger 
ones are apt to cause restlessness and more or less exaggera- 
tion in the reflex excitability. It is much less depressant to 
the higher cerebral centres than morphine, and has a decidedly 
stimulating effect upon the spinal cord, as well as the medulla 
and lower parts of the brain. Owing, it is believed, to its 
action on the cord, tetanic spasm is sometimes caused by 
large doses. In man it is much less constipating than mor- 
phine or opium, and in animals not infrequently has a purga- 
tive action. It has comparatively little effect in slowing the 
respiration, and, though the pupil is slightly contracted while 
the sleep it causes lasts, dilation is observed when the excite- 
ment stage follows. 

Therapeutics of Codeine. 
In diabetes it is frequently used for reducing the amount of 
sugar in the urine, which it does more effectually than opium 
itself. For this purpose it is usually given as a pill or in a 
syrup. It is, as mentioned, very efficient in relieving cough 
of all kinds, and is an excellent substitute for morphine as an 
ingredient of expectorant mixtures. It is also very useful for 
allaying ovarian pain and as an analgesic generally, and is 
especially esteemed in cases where, as often happens in malig- 
nant disease, an anodyne effect is required to be maintained 
more or less continuously. 
56 



866 PHARMACOLOGY AND THERAPEUTICS. 

The other more important alkaloids of opium are the fol- 
lowing: 

Papaverine. — This is regarded as occupying a position mid- 
way between morphine and codeine as regards its action on 
the central nervous system, but it is very much less powerful 
than either. After large quantities some tetanic spasm may 
be produced by its action on the spinal cord, and, by a direct 
action on the cardiac muscle, the rhythm of the heart is 
slowed by it. 

Anarcotine (known also as narcotine) is even less depres- 
sant than codeine, and reflex stimulation characterizes its action. 
It is an antiperiodic and valuable in the prevention as well as 
the treatment of malarial fever. 

Thebaine (paramorphine), rather than a depressant, has a 
stimulating character, which appears to be identical with, 
though much feebler than that of strychnine. It has been found 
to increase peristalsis in the intestine. 

HYDRATED CHLORAL. 

CHLORALUM HYDRATUM.— Hydrated Chloral. (Chloral U. S. 
P., 1890.) Dose, 1 gm.; 15 gr. 

Unofficial Preparations. 
Hypnalum. — Hypnal. (Antipyrine Monochloral.) Dose, 1 
gm.; 15 gr. 

Hypnonum. — Hypnone. (Phenyl-methyl-acetone.) Dose, 0.30 
to 0.60 c.c; 5 to 10 TTt. 

Somnalum. — Somnal. (Ethylirtes Chloral-urethane.) Dose, 1 
to 4 c.c; y 4 to 1 fl. dr. 

Action of Hydrated Chloral. 
External. — Like chloroform, chloral has marked antiseptic 
properties. Locally, it is irritant, and at the same time anaes- 
thetic. Applied to the unbroken skin in concentrated solution 
it causes redness and sometimes vesication. On raw surfaces 



HYDRATED CHLORAL. 867 

it has a decided corrosive action, and when injected subcuta- 
neously is liable to excite considerable irritation. 

Internal. Alimentary Canal. — Unless well diluted, it is irri- 
tant to the gastro-intestinal mucous membrane, and is there- 
fore apt to occasion nausea, vomiting and purging. 

Blood. — Chloral was first introduced as a hypnotic under the 
supposition that it was decomposed in the blood and chloroform 
liberated, but it is now known that it circulates unchanged, 
since no chloroform is found in the blood or expired air, and 
the drug itself is present in the urine both in a free state and 
in combination with glycuronic acid. 

Circulation. — Large amounts, by depressing the vaso-motor 
centre in the medulla and by direct action on the cardiac muscle, 
have the effect of slowing and weakening the heart and of 
producing a fall of blood-pressure. It is thought probable also 
that the action of the drug on the muscular walls of the vessels 
has some influence in reducing the arterial tension. The same 
alterations in the heart are produced as by chloroform, the 
auricular contractions becoming weak before the ventricular, 
and some dilatation occurring in both cavities. In fatal poison- 
ing the heart is arrested in diastole. In consequence of the 
vaso-motor paralysis, there results a marked dilatation of the 
cutaneous blood-vessels, and this may give rise to eruptions on 
the skin. Moderate doses usually have little effect on the pulse 
or blood-pressure, though these may possibly be transiently 
raised. Sometimes, however, even small amounts have a dis- 
tinctly depressing effect upon the heart. 

Respiration. — Under large doses the respiratory movements 
become more and more slow and shallow from the depressing 
action of the drug on the medullary centre, which may be aided 
by the extreme weakness of the heart. In fatal cases death 
usually occurs from paralysis of the respiratory centre, though 
sometimes, as in the case of chloroform, it is due to paralysis 
of the weakened heart. With moderate doses the respiration 
becomes slower and weaker, but scarcely more so than in nat- 
ural sleep, in which the excitability of the respiratory centre and 






868 PHARMACOLOGY AND THERAPEUTICS. 

the volume of the inspired air appear to be very much the same 
as after small amounts of chloral. ' 

Central Nervous System. — Chloral is the purest hypnotic we 
possess. It has the effect of depressing and eventually com- 
pletely paralyzing the central nervous system. Under its influ- 
ence there is a successive depression, first of the brain, then of 
the spinal cord, and finally of the medulla oblongata. With 
small doses, therefore, it is often possible to confine the action 
of the drug entirely to the cerebrum, with the result of pro- 
ducing a sleep closely resembling ordinary sleep. Under some- 
what larger quantities the sleep is more profound, and there is 
a depression of the spinal reflexes, while under still larger 
amounts the depression extends to the medullary centres, which 
are finally paralyzed. Chloral differs from morphine in ap- 
parently having no specific action on the analgesic areas of the 
brain ; so that acute pain is apt to prevent sleep after it. While 
a powerful hypnotic, it is not, therefore, an analgesic. It has 
also less influence on the sensibility of the skin than morphine, 
though very large doses cause anaesthesia. The pupil is al- 
ways contracted under chloral. The irritability of the motor 
areas of the cerebral cortex is reduced by it, and they finally 
fail to respond to the strongest electrical stimulation. The 
spinal reflexes become paralyzed before the failure of the res- 
piration. In the frog it has been observed that the depression 
of the reflex irritability may be preceded by a temporary in- 
crease, but this is believed to be probably due rather to the 
remote effects of the local irritation than to the direct action 
of the drug on the cord. Chloral appears to have no action 
on muscle or nerve when taken internally or injected into the 
circulation, but when applied to an exposed nerve it is found first 
to irritate and then paralyze it, and, when injected directly into 
the artery of a muscle, to produce immediate rigor. After the 
sleep caused by it the patient usually awakes refreshed, and free 
from headache or other disagreeable symptoms, though occa- 
sionally nausea and discomfort are felt. 

Temperature. — Chloral causes a considerable reduction in the 



HYDRATED CHLORAL. 869 

temperature, and this is largely due to the diminished heat pro- 
duction from the lessened muscular activity. Another factor, 
no doubt, is the increased output from the dilatation of the 
cutaneous vessels, and it is possible also that the irritability of 
the heat-regulating centres in the brain may be diminished. 

Skin. — Chloral habitues often present peculiar purplish 
blotches upon the face. 

Metabolism. — There appears to be an increased destruction 
of proteids, with a more or less incomplete oxidation of waste 
products. The acidity of the urine is found to be much in- 
creased by the presence of urochloralic acid (a combination of 
chloral and glycuronic acid), and the alterations in the metab- 
olism are attributed to the excessive production of this acid 
in the tissues. It is to be noted also that less oxygen is ab- 
sorbed and less carbon dioxide given off in consequence of the 
lessened muscular movement. 

Excretion. — It is excreted mainly by the kidneys as chloral 
and more largely as urochloralic acid. Part of it, however, 
is thrown into the stomach, and to this circumstance may pos- 
sibly be due, it is thought, the gastric irritation which, as men- 
tioned, is in some instances experienced on awaking from the 
sleep caused by chloral. 

Therapeutics of Hydrated Chloral. 

External. — Chloral is used to some extent as a rubefacient 
and counter-irritant, as well as an antiseptic, but it is more 
expensive than many other equally effective remedies. As a 
wash or dressing for suppurating wounds, cancer of the uterus, 
foul ulcers, etc., it may be applied in a solution of the strength 
of .30 to .60 gm. (5 to 10 gr.) to 30 c.c. (1 fl. oz.), and for 
bromidrosis or hyperidrosis in solutions of from 2 to 5 per 
cent. A 1 per cent, solution has been found efficient as an 
injection in gonorrhoea, and a 10 per cent, solution as an injec- 
tion (into the sac) for hydrocele. The same may be injected 
into the neighborhood of varicose veins, with the effect of caus- 
ing gradual coagulation of the blood and contraction of the 



87O PHARMACOLOGY AND THERAPEUTICS. 

vessels. The injection per rectum of from 1 to 1.60 gm. (15 
to 25 gr.) of chloral, properly diluted, has been used as a 
remedy for haemoptysis. The continued application of a solu- 
tion of 4 gm. (1 fl. dr.) in 16 c.c. (4 fl. dr.) each, of glycerin 
and water, has been recommended as a successful treatment for 
furuncle. Chloral solutions (about 5 per cent.) may be applied 
to parasitic skin diseases, such as tinea versicolor, and used to 
allay itching in eczema, prurigo, etc. The powdered drug in- 
corporated in ointments is also of service in relieving the itch- 
ing of cutaneous affections. In urticaria the following lotion 
has been employed : Chloral, 5 ; boric acid, 30 ; distilled water, 
180 parts. In combination with other remedies it is used as 
a local anodyne and counter-irritant in neuralgia, pleurodynia, 
lumbago and other painful affections. An excellent prepara- 
tion of this kind is composed of equal parts of chloral, camphor 
and menthol, rubbed up together to form a liquid. It may be 
applied to aching teeth and also to the larynx to relieve pain. 
It is also an effective preparation for rubbing into the legs to 
relieve painful cramps in the calves. 

Internal. — Chloral has the advantages of being a promptly- 
acting and certain hypnotic. It is far from being a safe one, 
however; it depresses the heart and respiration so markedly 
that the prescriber should be always upon his guard. It does 
not relieve the distress and cough of disease of the heart and 
lungs, and must naturally be given, if at all, with special cau- 
tion when these organs are affected. It had better be avoided 
for the most part, also, when stomach or bowel troubles are 
present, as it is very liable to increase the irritation of these 
parts. In the insomnia of fevers it is often of great service 
in the early stages, but as the disease progresses, the weakness 
of the heart may contra-indicate its use. As has been stated, 
it is of no value in producing sleep in cases in which insomnia 
is due to pain from any cause. It has been used as a cerebral 
depressant in puerperal convulsions, delirium tremens, and 
mania, but very large doses are usually required, and the effects 
of the drug must be watched with great care. Cases are re- 



HYDRATED CHLORAL. 8/ I 

corded in which it has caused sudden death in alcoholics with 
fatty heart. In threatened delirium tremens, however, sleep 
may sometimes be induced by quite moderate doses in associa- 
tion with potassium or sodium bromide. It is of special value 
in sleeplessness from mental over-work, worry, etc.. and in other 
forms of nervous insomnia. A very important use of chloral 
is in midwifery; here it has been designated the medicinal for- 
ceps. Frequently after rest has been obtained by this drug 
labor proceeds vigorously and is rapidly terminated. It has 
been employed with more or less success in incontinence of 
urine, tetanus, and poisoning by strychnine, physostigma and 
picrotoxin. If on account of spasm the patient is unable to 
swallow, it may be administered by the rectum. It is especially 
indicated in tetanus and strychnine poisoning because it de- 
presses the motor tract of the spinal cord. It is a safer remedy 
for children than for adults, and is often prescribed for infan- 
tile convulsions, chorea, laryngismus stridulus, whooping- 
cough, and other spasmodic affections. It sometimes acts very 
happily in controlling or alleviating the paroxysms of whoop- 
ing-cough. Chloral is of considerable value in seasickness, 
and may sometimes be efficacious in the morning sickness of 
pregnancy, especially in cases in which there is much dizziness, 
faintness, and repugnance to food, with but little vomiting. 
Should the odor of the drug tend to excite nausea, it may be 
given by the rectum. Administered in this way it has been 
advised for other forms of nausea and vomiting of reflex origin, 
such as occur in uterine fibroids and various other conditions. 
Notwithstanding the theoretical objections to the use of the 
drug in gastro-intestinal disorders, in severe cholera morbus, 
with symptoms of collapse, and in true cholera the hypoder- 
matic injection of chloral is considered by some the most effec- 
tive treatment that we have, and especially when morphine is 
employed with it. A favorite vehicle for the administration of 
chloral is syrup of tolu, and its unpleasant taste can be con- 
cealed by giving it in bottled " lemon soda." 

Hypnal is a compound of chloral with antipyrine made by 



872 PHARMACOLOGY AND THERAPEUTICS. 

mixing their solutions, and is obtained in crystalline form. It 
was proposed as a hypnotic, more certain than chloral, nearly 
free from taste, entirely free from irritating effect upon the 
mucous membranes, and having distinct analgesic effects. It 
has been but little used. 

Hypnone, while not a very powerful hypnotic, is said to be 
especially useful in the insomnia of alcoholism. In moderate 
doses it is ordinarily devoid of danger, its only unpleasant 
result being a disagreeable odor left on the breath. In very 
large doses it has induced coma, followed by cardiac and res- 
piratory paralysis. 

Somnal is regarded as a fairly satisfactory hypnotic, but, 
like other agents of its class, it will not always produce the 
desired effect. 

TOXICOLOGY. 

Acute Poisoning. — The symptoms of poisoning, as might naturally 
be supposed from the physiological action of the drug, closely resemble 
those of opium. Thus, there is profound coma, with weak and slow 
respiration and pulse and lividity of the surface. There is complete 
muscular relaxation, the reflexes are abolished, and the pupils contracted. 
The temperature is depressed, and the skin cold and clammy. The 
action of the heart is irregular as well as weak, and before death may 
become rapid. The pulse should always be carefully watched whenever 
chloral has been administered. It frequently happens that symptoms 
of failing heart come on unexpectedly even after small doses. 

Treatment. — The stomach should be evacuated by the stomach tube. 
Emetics (see p. 175) may be employed, but are of less value on account 
of the depressing action of the drug on the medullary centres. Artificial 
warmth must be supplied by means of hot bottles and blankets, and the 
temperature maintained also by friction and massage. Somnolence is to 
be resisted by injecting strong coffee into the rectum and by such 
measures as flagellation, douches, flapping with wet towels, and shout- 
ing at the patient. On account of the cardiac depression, the patient 
should not be forced to take active exercise, such as brisk walking. The 
inhalation of amyl nitrite may be employed to stimulate the heart, and 
strychnine or caffeine subcutaneously injected to stimulate the respira- 
tion. Artificial respiration may also be called for. 

Chronic Poisoning. — The chloral habit is very easily acquired by 
persons who have used the drug in ordinary doses for even a short 



BUTYL-CHLORAL HYDRATE. 873 

time continuously for the relief of insomnia or other purpose, and, once 
established, it produces serious results and is very difficult to break up. 
The patient suffers from digestive disturbances, marked physical and 
mental weakness, with sudden flushings due to vaso-motor derangement, 
from palpitation of the heart, and from erythematous eruptions, gener- 
ally of a purplish color, especially found on the face. In some instances 
there are bed-sores, ulcerations and sloughs. Dyspnoea, dependent upon 
the cardiac and respiratory depression and the general cachexia, is a 
prominent symptom. Sleep can be secured only by the accustomed 
hypnotic, and an over-dose may at any time result in collapse and 
death, since by reason of the cumulative effects of the poison in the 
system the vital functions are greatly impaired and elimination may be 
rendered impossible. It is to be noted also that the sudden withdrawal 
of the drug may lead to symptoms resembling those of delirium tremens, 
and as fatty degeneration of the heart is likely to be present, such a 
development is sometimes attended with the gravest danger. 

Unofficial Preparation. 
Butyl-CMoral Hydras (B. P.).— Butyl-Chloral Hydrate. 
(Croton Chloral Hydrate.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

Action of Butyl-Chloral Hydrate. 
The action of butyl-chloral hydrate is apparently identical 
with that of chloral. It has been claimed that it is much less 
depressant to the heart and circulation; also that it possesses 
more analgesic power than chloral and that it has a specific 
anaesthetic action on the nerves of the face and head. These 
statements, however, have been denied by writers of high 
authority, who assert that such claims have been disproved by 
the results of experimental research. 

Therapeutics of Butyl-Chloral Hydrate. 
Whether the drug has the specific analgesic action alleged 
or not, there is some clinical evidence going to indicate that 
it may be preferable to chloral in insomnia due to pain. On 
the whole, however, it has failed to sustain itself, and is less 
used now than formerly. Some have found it very efficacious 
in facial neuralgia and migraine, particularly when the fifth 



874 PHARMACOLOGY AND THERAPEUTICS. 

nerve is involved, but in the experience of others, if it has 
afforded any relief in tic douloureux and similar painful states, 
the effect has been only temporary. It has been recommended 
in the headache and neuralgia associated with carious teeth, in 
headache of pregnancy, in neurasthenic headaches and those 
due to eye-s.train, and also in dysmenorrhea and sciatica. 

CHLORALFORMAMIDUM.— Chloralformamide. (Chloralamide.) 
Dose, 1 gm.; 15 gr. 

Action of Chloralformamide. 

This compound appears to have the cerebral action of chloral, 
without its depressing effects upon the circulation; the latter 
being counteracted by the stimulating influence of the forma- 
mide. In poisonous doses only does it produce any noteworthy 
depression. It is also less liable to produce gastric irritation 
than chloral, but would seem to be somewhat slower and less 
certain in its hypnotic effect. Chloral is formed by its decom- 
position in the body, and fatty degeneration is said to have been 
observed after its prolonged administration. Cutaneous erup- 
tions are sometimes produced by it. 

Therapeutics of Chloralformamide. 
Chloralformamide may be employed in all cases in which 
chloral is indicated. It usually induces calm, refreshing sleep 
without any unpleasant after-effects, but in some instances 
causes confusion, dizziness and headache. It is generally re- 
garded as of no more service than chloral in insomnia due to 
pain, but some claim that it has a distinct anodyne effect, and 
that it is useful in neuralgia and in the pains of tabes dorsalis. 
It has been given with good results in some cases of nocturnal 
epilepsy and also in chorea. There seems to be no question 
that it is better borne than chloral when cardiac weakness is 
present, and it has sometimes been found to give relief in asth- 
matic symptoms due to heart trouble. If given for sleepless- 
ness at night in the form of capsule or powder, it is advisable, 
on account of the slowness with which it is absorbed, that the 



CHLORATONE. 875 

dose should be administered rather early. Perhaps the best 
way to give it is dissolved in a little alcohol. 1.20 gm. (20 
gr.), or more, may be dissolved in a sufficient quantity of 
brandy, and then water added at a temperature not above 54.4 
C. (130 F.). It may also be administered very satisfactorily 
in a watery solution with syrup and a little dilute hydrochloric 
acid. 60 c.c. (10 TTL) of aromatic sulphuric acid added to 30 c.c. 
(1 fl. oz.) of water will generally dissolve 2 gm. (30 gr.) of 
chloralformamide, but not always, as some specimens of the 
drug are very insoluble. It may be given by the rectum as well 
as the mouth. Remarkable results have been obtained in seasick- 
ness from the use of chloralformamide in association with potas- 
sium bromide. In order to secure the best effect it is advised 
that the patient should take a cholagogue for two days before 
sailing. As soon as he gets on board the ship he should take 2 
gm. (30 gr.) of each drug on an empty stomach, and at once 
go to bed and sleep. This combination may be of service in 
acute mania and other forms of insanity, and has been used in 
a proprietary medicine known as " chlorobrom." In using 
chloralformamide continuously it is not necessary to increase 
the dose, and with it there appears to be less danger of the 
patient's becoming an habitue of the drug than in the case of 
chloral. 

Unofficial Preparation. 
Chloretonum. — Chloretone. (Trichlor-tertiary. Butyl Alcohol. 
Acetone-Chloroform.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

Action of Chloretone. 
Without markedly influencing respiration or blood-pressure 
it produces anaesthesia and sleep. The hypnotic effect is ob- 
tained by the use of smaller amounts than are required in the 
case of chloral. It directly affects sensory nerves, and so may 
be used as a local anaesthetic. After excessive doses of it 
dogs may sleep for several days, finally succumbing from 
asphyxia. Since neither acetone nor chloroform are found 
in the expired air or the urine, and the chlorides are increased 
in the latter, it is probably broken up in the body. 



8y6 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Chloretone. 
In one per cent, solution it may be applied as a local anaes- 
thetic to ulcers and infected wounds. Internally, its chief use 
is as a hypnotic which is both safe and generally efficient. In 
moderate -doses it promptly relieves irritability of the stomach. 

Unofficial Preparation. 
Anhydrogluco-Chloralum. — Anhydrogluco-Chloral. (Chlo- 
ralose.) Dose, 0.10 to 0.25 gm.; 2 to 4 gr. 

Action of Chloralose. 
Chloralose will produce sound sleep in which sensibility is 
not lost, although the reflex activities are greater than usual. 
By its excitation of the spinal cord the reflexes may be increased 
until convulsions resembling those of strychnine result. The 
sleep is caused by its depressant action on the functions of the 
brain, and the awakening is without unpleasant effects. Unless 
very large doses are given the heart and respiration are not 
acted upon. 

Therapeutics of Chloralose. 
Chloralose on account of its bitter taste is best given in cap- 
sules. .60 gm. (10 gr.) have produced profound unconscious- 
ness, so that caution should be exercised in prescribing it. This 
drug has been known to produce diplopia, muscular tremors, 
and other unpleasant results, and if a habit is induced by its 
constant use, it is said that its hypnotic influence is diminished, 
while the untoward effects are more likely to be marked. In 
nervous and tuberculous patients it may possibly give rise to 
tetanic or cataleptic symptoms, with disturbance of the mental 
faculties. 

Unofficial Preparation. 
Bromalum, CBr 3 COH.— Bromal. Dose, 0.12 to 0.24 gm.; 2 to 
4 gr. 

Action of Bromal. 
It resembles chloral in its chemical properties, like it exist- 
ing as an oily colorless liquid, or, when united with water or 



PELLOTINE. 877 

alcohol, as a crystalline hydrate or alcoholate. It is prepared 
by slowly adding from 3 to 4 parts of bromine to refrigerated 
alcohol; the mixture being distilled after fifteen or twenty 
hours of contact. It depresses the heart like chloral, but is 
much more poisonous. In several respects, however, it differs 
from chloral in its action. In animals it causes at first rest- 
lessness and excitement and afterwards stupor, which is often 
accompanied by dyspnoea, and terminates in respiratory failure 
or in convulsions. There are marked contraction of the pupil 
and profuse salivation. 

Therapeutics of Bromal. 
.18 gm. (3 gr.) administered at bedtime are said to have 
produced sleep or relieved pain, but the drug appears to be 
distinctly dangerous, and scarcely deserves a place in medicine. 

Unofficial Preparation. 
Amyleni Hydras.— Amylene Hydrate. (Dimethylethyl-carbi- 
nol. Tertiary Amylic Alcohol.) Dose, 2 to 4 C.C.; y 2 to 1 fl. dr. 

Action of Amylene Hydrate. 
Amylene hydrate is a hypnotic, about midway in power be- 
tween chloral and paraldehyde, and having a pleasanter taste 
than the latter. The sleep is generally natural, and the awaken- 
ing prompt and complete. It is a safe hypnotic, having but little 
action upon the heart or respiration, and it appears also to have 
anodyne properties. 

Therapeutics of Amylene Hydrate. 
It can be administered in wine, raspberry syrup, or simply 
in water. It has been given hypodermatically, with one-half 
its volume of alcohol. After continued use it is apt to dis- 
agree with the stomach. 

Unofficial Preparation. 
Pellotinum. — Pellotine (an alkaloid of Anhalonium). Dose, 
0.03 to 0.06 gm.; y 2 to 1 gr. (hypodermatically). 



8y8 PHARMACOLOGY AND THERAPEUTICS. 

Action of Pellotine. 
In frogs slight narcosis follows its injection in from ten to 
fifteen minutes. The reflexes are somewhat diminished. After 
twenty to thirty minutes there appears a distinct increase 
of reflex irritability, followed by spasms, resembling strychnine 
poisoning. If large doses are administered this condition may 
pass into one of complete paralysis. In man the pulse rate is 
slightly diminished, and drowsiness and sleep supervene. It 
apparently has no effect on the secretions. The drug is prob- 
ably excreted by the kidneys. 

Therapeutics of Pellotine. 
Pellotine has been recently introduced as a hypnotic which, 
because it is unirritating, can be used hypodermatically. With 
the slight slowing of the pulse, it induces a feeling of weariness, 
weight of eyelids and limbs, and disinclination to mental and 
bodily exertion, and a quiet sleep follows. The awakening is 
easy and usually without untoward symptoms. In full doses, 
with the patient in an upright position it may give rise to 
vertigo. It is somewhat analgesic, as well as hypnotic, and 
has afforded relief to the pains of locomotor ataxia and 
peripheral neuritis. 

SULPHONMETHANE. 

SULPHONMETHANUM. — Sulphonmethane. (Diethyl sulphonedi- 
methylmethane. Sulphonal.) Dose, 1 gm.; 15 gr. 

Action of Sulphonmethane. 
Sulphonmethane, or Sulphonal, while a less efficient hypnotic 
than chloral, is also less dangerous, as it has no depressing 
cardiac action. It does not affect the heart directly, though it 
may cause a slight quickening of the pulse through its depres- 
sant effect upon the inhibitory centre. Through its action on 
the central nervous system it also has some influence in dimin- 
ishing metabolism. Its excretion appears to be slower than its 
absorption, so that there is a tendency to a cumulative action, 



SULPHONMETHANE. 879 

This may lead to gastritis, renal disease, and certain changes 
in the blood which are not very clearly understood. In conse- 
quence of the latter there is a characteristic discoloration of 
the urine, due to the presence in it of a reddish-brown pigment, 
haematoporphyrin, which is an iron-free product of the decom- 
position of hsematoglobin. This is found to occur chiefly in 
anaemic women, and is accompanied by constipation, vomiting 
and gastric pain, weakness and ataxia, confusion and partial 
paralysis, while eventually there may result suppression of the 
urine or collapse and death. Several fatal cases of poisoning 
by this drug have been reported from small doses continued for 
long periods. Sulphonal does not often lead to a habit, but 
cases of this are sometimes met with. Though its continued 
use may not induce the very grave results mentioned, it may 
be attended by severe functional disturbances. Persons taking 
it regularly for a considerable time are liable to suffer from 
mental, moral and muscular weakness, indigestion, impaired 
nutrition, and persistent cutaneous eruptions. The untoward 
effects of the drug can usually be avoided by intermitting its 
administration from time to time. It is thought to have some 
deleterious action on the heart when used for long periods, 
and is found to be a much less certain hypnotic in cases of 
cardiac disease than in other conditions. Very large quanti- 
ties of sulphonal have been taken without fatal results, and in 
fact without any more serious consequences than prolonged 
unconsciousness. An enormous single dose, however, has been 
known to cause paralysis of the sphincters, anuria, a fall of 
temperature, and, late in the case, depression of respiration. 
Very large amounts are said to produce convulsive movements 
in animals. The drug is largely decomposed in the body, and 
excreted in the urine as ethylsulphonic acid, but a small portion 
escapes unchanged. Sulphonal has little or no effect in reliev- 
ing pain. As its absorption is very slow on account of its 
insolubility, sleep is somewhat late in following its administra- 
tion, and not infrequently more or less drowsiness and depres- 
sion are experienced the next day. 



880 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sulphonmethane. 
Sulphonal is used exclusively to produce sleep. It is prefer- 
ably administered in hot water, but on account of their con- 
venient form, it is often given in wafers or tablets. These 
should be taken at least an hour and a half before the time 
when sleep is desired. 

SULPHONETHYLMETHANE. 

SULPHONETHYLMETHANUM.— Sulphonethylmethane. ( Diethyl 
sulphonmethylethylmethane. Trional.) Dose, 1 gm.; 15 gr. 

Unofficial Preparation. 
Tetronalum. — Tetronal. (Diethyl sulphondiethylmethane.) 
Dose, 1 to 2.40 gm.; 15 to 40 gr. 

Action of Trional. 
Sulphonethylmethane, or Trional, is a prompt hypnotic, with- 
out cumulative action, and it has no injurious or unpleasant 
after-effects. Apparently the patients do not become habitu- 
ated to its use. 

Therapeutics of Sulphonethylmethane. 

As it is more soluble, quickly absorbed and active, trional is 
generally preferred to sulphonal. It has been used as a hyp- 
notic and sedative for the insane; for narcotic habitues, so far 
as is known, it is a safe remedy. It is important that the daily 
action of the bowels be secured, an alkaline water be given 
daily, and weekly intermissions be insisted upon; otherwise it 
may give rise to disagreeable after-effects. It but rarely pro- 
duces hsematoporphyrinuria. As in the case of sulphonal, 
multiple neuritis may very rarely follow the prolonged admin- 
istration of small doses of trional. 

Tetronal is of similar chemical composition, containing four 
instead of three ethyl groups, and is used for the same pur- 
poses, but in somewhat larger dose. 



VERONAL. 50 1 

VERONAL. 

Unofficial Preparation. 

Veronalum. — Veronal. Dose, 0.5 to 1.5 gm.; iy 2 to 22y 2 gr. 
in hot liquids. 

Action of Veronal. 

External. — None. 

Internal. Alimentary Canal. — It does not usually cause nau- 
sea, vomiting or any gastric disturbance. 

Blood. — It probably has no effect upon the blood, for no blood 
pigments appear in the urine. 

Circulation. — It does not influence arterial tension, nor does 
it have any effect upon the pulse rate. 

Skin. — A slight antipyrine-like rash, has been observed in a 
few instances, accompanied by itching. 

Respiration. — There is no effect. 

Temperature. — This is slightly lowered two or three hours 
after a moderate dose has been taken. 

Brain. — Sleep generally ensues within an hour after the in- 
jection of the drug and is likely to last from four to ten hours. 
The awakening may be accompanied by some torpor. 

Spinal Cord. — There is a possible analgesic action. 

Excretion. — The urine usually remains normal, free from 
albumin, sugar, and blood pigment. In very rare instances 
the drug causes hsemato-porphyrinuria. The nitrogen excre- 
tion is diminished. 

Therapeutics of Veronal. 
The remedy is useful in the treatment of insomnia of 
varied causation. It is especially useful in the simple in- 
somnia and sleeplessness of neurasthenic or hysterical origin. 
In conditions of excitement the maximum dose should be em- 
ployed. Since it is without action upon the circulation or 
respiration it may be administered to patients suffering from 
cardiac or pulmonary diseases. As it does not increase the 
nitrogenous output of the kidneys it can be safely given to 



i 



882 PHARMACOLOGY AND THERAPEUTICS. 

debilitated individuals, and for considerable periods of time, 
as well as in febrile conditions and wasting disorders. As it is 
safe for continued use, reasonably sure in its results, possesses 
comparative freedom from habituation, and produces a sleep 
approaching the normal, it is a valuable addition to the avail- 
able hypnotics. The perspiration of pulmonary tuberculosis, it 
may be noted, is sometimes diminished by evening doses of 
the drug. 

Untoward Symptoms. — These occur but infrequently and are 
the exanthem already mentioned, loss of appetite, nausea, vom- 
iting, diarrhoea, headache, vertigo, and rarely torpor lasting 
through the following day. Cumulation is not to be anticipated. 

TOXICOLOGY. 

Symptoms. — In a single instance febrile reaction for six or eight days, 
dryness of the mouth, burning sensation in the throat, a morbilliform 
exanthem on the face, extending to the chest and arms, becoming con- 
fluent, followed by a vesicular and bullous eruption upon the buccal 
and pharyngeal mucous membranes, conjunctivitis, and pain in the ears, 
has been observed. 

Treatment. — Interruption of the treatment, or alternation with hyp- 
notics of other series, administration of the alkaline mineral waters, with 
the securing of a daily movement of the bowels, will obviate these symp- 
toms. 

PARALDEHYDE. 

PARALDEHYDUM.— Paraldehyde. Dose, 2 C.C.; 30 Til. 

Action of Paraldehyde. 

External. — It is antiseptic and antifermentative. 

Internal. — Paraldehyde is a prompt, powerful and safe hyp- 
notic. The system is usually very tolerant of it, and it may 
be continued and found useful for long periods. In animals, 
in which it acts in the same manner as upon man, it depresses 
the higher nervous centres first; later it diminishes the re- 
flexes, and finally there is a marked effect on the spinal cord. 
The anterior cornua are paralyzed, and there are abolition of 
reflex action, paralysis and anaesthesia. Fatal results from it 



PARALDEHYDE. 883 

are rare, but enormous quantities may cause death by para- 
lyzing the respiratory centre in the medulla. Its action on the 
heart is similar to that of sulphonal, causing a slight accelera- 
tion of the pulse by its depressant effect upon the inhibitory 
centre. It often produces gastric irritation and an increased 
flow of urine. It is chiefly excreted by the kidneys, but in part 
also by the lungs, and the odor of the drug may be detected in 
the breath for some time after its hypnotic effect has passed 
off. An erythematous rash is sometimes caused, and its pro- 
longed use is said to have induced gastric catarrh and ulcers 
about the nose. Diarrhcea has also been observed. Instances 
of the paraldehyde habit have been occasionally reported. 
There is great emaciation, cardiac weakness, unsteady gait, 
mental confusion and agitation, with hallucinations of sight 
and hearing and unpleasant delusions. Restraint for several 
months is necessary for cure. 

Therapeutics of Paraldehyde. 
Unlike chloral, paraldehyde may be given with safety in cases 
of cardiac disease. The principal objection to the drug is its 
disagreeable and burning taste, and hence it is usually admin- 
istered in capsules. If not given in this way, syrup and tinc- 
ture of orange peel (with at least 60 c.c. ; 2 fl. oz. of water, 
so as to insure the dissolving of the paraldehyde) may be em- 
ployed to conceal the taste, or the drug may be administered 
in glycerin, in a 25 per cent, solution, which renders it more 
palatable. The large dose required is also a disadvantage. If 
paraldehyde is to be of service, it usually produces sleep in from 
fifteen to thirty minutes, and this is placid, dreamless and re- 
freshing. No lassitude or depression is experienced the follow- 
ing day, and the appetite often improves under its use. It is 
useful in most cases of simple sleeplessness, but is found to 
be of little service if there is any active pain, or if there is 
cause for worry and anxiety. To patients with gastric irrita- 
bility and in cases where there are convulsions it may be given 
by the rectum. Paraldehyde is principally used in institutions 



884 PHARMACOLOGY AND THERAPEUTICS. 

for the insane. It has been found valuable in all forms of 
mania, including the delirious mania due to alcohol or epilepsy. 
In cases of melancholia it may induce sleep, but is often dis- 
appointing. It is useful in mental excitement associated with 
chorea, and in many cases of senile excitement, with marked 
restlessness, it has been pronounced the best remedy. It has 
a certain value in convulsive diseases, and has proved of ser- 
vice in some cases of epilepsy, chorea and strychnine poisoning. 
It sometimes relieves the symptom asthma and the paroxysms 
of whooping-cough, but on account of its disagreeable taste and 
pungent odor it is not well suited for children. As an expec- 
torant, as well as an antispasmodic, it seems to be useful in the 
treatment of cough in general. It is said to have been effica- 
cious in some cases of polyuria. 

ETHYL CARBAMATE. 

-ffiTHYLIS CARBAMAS. — Ethyl Carbamate. (Urethane. Ethyl 
Ure thane.) Dose, 1 gm.; 15 gr. 

Action of Ethyl Carbamate. 
Urethane is a hypnotic, and is believed to induce a calm, 
natural sleep without any disagreeable after-effects. 

Therapeutics of Ethyl Carbamate. 
It was employed more frequently formerly than at present, 
as it so often proves disappointing. In some instances it ap- 
pears to act as an almost ideal hypnotic, but, unfortunately, 
there are many cases in which it has no effect. It is most 
successful in those in which there is no pain and where the sleep 
is wanting rather from habit than from any uneasy feeling or 
from worry. It has been found beneficial in children and in 
some cases of sleeplessness following fevers or the result of 
alcoholic excess; also in some instances where other more 
powerful drugs, such as chloral, have been taken for some time 
and where the patient feels that he must have sedatives to help 



HOPS. 885 

him to sleep. It does not appear to be of much service among 
the insane. 

HOPS. 

HUMULUS.— Hops. Dose, 2 gm.; 30 gr. 

LUPULINUM.— Lupulin. Dose, 0.500 gm. (500 milligm.) ; iy 2 gr. 

Preparations. 

1. Fluidextractum Lupulini. — Fluidextract of Lupulin. Dose, 
0.5 c.c.; 8 Til. 

2. Oleoresina Lupulini. — Oleoresin of Lupulin. Dose, 0.200 
gm. (200 milligm.) ; 3 gr. 

Unofficial Preparation. 
Tinctura Humuli (U. S. P., 1890). — Tincture of Hops. Dose, 
4.0 to 8.0 c.c; 1 to' 2 fl. dr. 

Action of Hops. 
Like other volatile oils, its constituent, valerol, which to a 
slight extent also reflexly excites the circulation, is stomachic 
and carminative. ' The bitter principle likewise adds to the 
stomachic properties of the drug. Hops have an undoubted 
sedative and hypnotic influence, which is supposed to be prob- 
ably due to the volatile oil, but it is not very marked, and ap- 
pears to be subject to considerable variations. Lupulinic acid, 
when injected as a neutral salt into the blood, has been found 
to cause first stimulation and then paralysis of the medullary 
centres, but to have very little effect when given by the mouth, 
even in large doses. 

Therapeutics of Hops. 
Hops are used medicinally chiefly in the form of bitter ale, 
which derives from them its peculiar flavor and taste, as well 
as a certain degree of its heavy, soporific effect. Ale, stout, 
or good beer may sometimes serve to improve the appetite and 
digestion and to secure sleep, and such effects are naturally 
increased by the alcohol contained in them. Hops may some- 



886 PHARMACOLOGY AND THERAPEUTICS. 

times be employed with advantage in atonic dyspepsia, flatulent 
colic and mild diarrhoeas. Lupulin has been used in nervous 
tremors, wakefulness and the delirium of drunkards. Equal 
parts of fluidextract of lupulin and tincture of capsicum con- 
stitute an excellent substitute for alcoholic stimulants when it 
is desired to break off the use of the latter, and this combina- 
tion is also very useful for the wakefulness and excitement 
preceding a threatened attack of delirium tremens. Lupulin is 
supposed to have some value as an anaphrodisiac, and it is 
sometimes of service in spermatorrhoea. The oleoresin is here 
regarded as the best preparation. It has been recommended 
for chordee, but appears to have very little effect in this con- 
dition. A hop pillow often seems to have a soothing and 
soporific influence, but this result is doubtless to a great extent 
the effect of imagination and the association of ideas. So, hop 
poultices are used for their alleged anodyne action, but any 
benefit derived from them is to be attributed simply to the heat 
and moisture. 

LACTUCARIUM. 

LACTUCARIUM. — Lactucarium. (Lettuce.) Dose, 1 gm.; 15 gr. 

Preparations. 

1. Tinctura Lactucarii. — Tincture of Lactucarium. Dose, 2 
c.c; 30 TH.. 

2. Syrupus Lactucarii. — Syrup of Lactucarium. Dose, 8 c.c; 
2 fl. dr. 

Action of Lactucarium. 
Lactucarium has been credited with mild hypnotic powers. 
Fresh lettuce is said to contain traces of hyoscyamine, in addi- 
tion to lactucin, and since classic times has been known as tend- 
ing to induce slumber. Large doses of the green extract may 
cause mental derangement, and will dilate the pupil. 

Therapeutics of Lactucarium. 
It is quite unreliable as a hypnotic, but in some instances 
appears to have a quieting and soporific effect. It may be 



METHYLENE BLUE. 887 

tried as a substitute for opium and its alkaloids when these dis- 
agree. The syrup is sometimes added to cough mixtures as a 
sedative, especially for children, and has also been employed to 
allay nervous irritability and as a substitute for the soothing 
syrups containing opium. Aubergier's syrup of lactucarium 
(not official) has the reputation of being active and uniform 
in strength. 

METHYLENE BLUE. 

METHYLTHIONIN-ffi HYDROCHLORIDUM. — Methylthionine 
Hydrochloride. Methylene Blue. Dose, 0.250 gin. (250 milligm.) ; 
4 gr. 

Action of Methylene Blue. 
Methylene blue (not to be confounded with methyl blue) has 
been introduced into medicine as an antiseptic. It also possesses 
anodyne and diuretic properties. It imparts a blue color to 
nerve substance and a like color to the urine. 

Therapeutics of Methylene Blue. 
It has been used for rheumatism of the joints and muscles, 
migraine, sciatica and other neuralgias; also for alcoholic neu- 
ritis and the pains of locomotor ataxia. It would seem to be 
a remedy of some value for quieting patients suffering from 
incurable mental disease in which excitement is a prominent 
symptom. In a number of cases of mania and paretic demen- 
tia it produced a calmative effect which did not resemble the 
action of hypnotic drugs, but seemed rather a natural quietude. 
Lately it has been given for intermittent fevers, but the reports 
show that it possesses no advantage over quinine except its 
tastelessness. It may be substituted for quinine if the latter 
cannot be taken or has been unsuccessfully used. Recent reports 
indicate that even when given internally, it causes gonococci to 
rapidly disappear from the urine in specific urethritis. As to 
its effects upon inoperable neoplasms when injected into them 
clinical reports differ widely. It may produce irritation at the 



888 PHARMACOLOGY AND THERAPEUTICS. 

neck of the bladder, which about 2 gm. (30 gr.) of powdered 
nutmeg is said to relieve. 

(3) General Anaesthetics. 

CHLOROFORM. 

CHLOROFORMUM.— Chloroform. (Trichloromethane.) Dose, 0.3 
c.c; 5 m,. 

Preparations. 

1. Aqua Chloroformi. — Chloroform Water. Dose, 16 c.c; 
4fl. dr. 

2. Emulsum Chloroformi. — Emulsion of Chloroform. Dose, 
8 c.c; 2 fl. dr. 

3. Linimentum Chloroformi. — Chloroform Liniment. 

4. Spiritus Chloroformi. — Spirit of Chloroform. (Chloric 
Ether.) Dose, 2 c.c; 30 ul. 

Unofficial Preparation. 
Tinctura Chloroformi et Morphinae Composita (B. P.). — 
Compound Tincture of Chloroform and Morphine. Dose, .30 to 
1 C.C.; 5 to 15 Til. (This preparation is an imitation of the 
proprietary remedy known as Chlorodyne. Among its principal 
ingredients are chloroform, tincture of cannabis indica, tincture 
of capsicum, and morphine hydrochloride.) 

Action of Chloroform. 
External. — The local action of chloroform quite resembles 
that of alcohol, but is more energetic. It is also more power- 
fully antiseptic. Chloroform is a protoplasmic poison of great 
intensity, and no living substance is capable of withstanding its 
lethal effect if exposed to its concentrated vapor for a sufficient 
time. Its evaporation on the skin has a refrigerant effect, and 
hence causes contraction of the blood-vessels and anaesthesia at 
the point of application. If, however, the vapor is confined, or 
if chloroform is rubbed into the skin, it has the effect of causing 
heat and redness, with dilatation of the local vessels; and the 
irritation may be sufficient to produce vesication. While when 



CHLOROFORM. 889 

locally applied it is more irritant to mucous membranes than 
ether, yet when inhaled it is less irritant than the latter to the 
respiratory tract. 

Internal. Alimentary Tract. — In the mouth it causes, in con- 
centrated form, a burning sensation and pain, followed by anaes- 
thesia, and increased secretion of saliva and mucus by reflex 
excitation of the glands. In the stomach and intestine it is 
also markedly irritant, often causing violent gastro-enteritis. 
In small doses its action is very much like that of the volatile 
oils, producing in the stomach a sense of warmth and comfort 
and inducing increased peristalsis. Absorption, it is believed, 
takes place more rapidly than in the case of the volatile oils. In 
the intestine it may perhaps have a slightly astringent effect. 

Blood. — Chloroform is absorbed into the blood from the 
gastro-intestinal tract, and, if administered by inhalation, from 
the lungs, and after absorption is thought to form a loose com- 
bination with the cholesterin and lecithin in the blood, perhaps 
in the red corpuscles. 

Nervous System. — The effects of the drug, when inhaled, are 
commonly divided into three stages. It must be borne in mind, 
however, that there are no sharply denned dividing lines be- 
tween them, and that they are simply different degrees of the 
same action. For convenience of study they may be named 
the stimulant, the anaesthetic, and the paralytic. 

First Stage. — There is a more or less marked preliminary 
feeling of asphyxia, but with this exception, the sensations are 
rather pleasant than otherwise. There is a sense of warmth 
experienced first about the face and head, but afterwards ex- 
tending throughout the body, while the imagination is tem- 
porarily excited. The patient's comfort, however, may be dis- 
turbed by the local effects, such as pricking and smarting of 
the nose, throat and conjunctiva, accompanied by increased 
secretion of saliva, mucus and tears. Vomiting may possibly 
occur, but is rare at this period. The mind becomes confused 
from the irregular stimulation of the higher cerebral functions, 
but this stimulation is only evanescent, and the patient soon be- 



89O PHARMACOLOGY AND THERAPEUTICS. 

gins to lose consciousness. Hallucinations are apt to be present, 
and the special senses are disturbed, so that he experiences un- 
usual sensations of light and ringing, hissing and roaring in the 
ears. There is formication and a feeling of stiffness in the 
muscles and of inability to move the limbs. He loses his 
self-control, and gives way to manifestations which vary with 
his character — loud talking, laughing, singing, weeping, swear- 
ing, etc. The general sensibility becomes blunted, but is not 
abolished. With the depression of the higher functions comes 
on excitation of the lower motor functions, and the patient 
now often begins to struggle violently. He will kick, fight and 
throw his arms and legs about to such an extent that it is diffi- 
cult to restrain him. These motor phenomena vary greatly in 
different individuals, and in some instances, especially in chil- 
dren, are entirely absent. Occasionally, and particularly in 
hysterical subjects, convulsions are observed. In this stage 
usually the pupils are somewhat dilated, the skin warm and 
moist, the face flushed or cyanotic, the pulse accelerated, and 
the apex-beat augmented. The respiration is generally slightly 
quickened, but may be more or less irregular, at first in conse- 
quence of the sensation of asphyxia and later from the 
struggling. 

Second Stage. — The inhalation being maintained, the move- 
ments cease and the muscles become relaxed. In consequence 
of this relaxation, the face, which is now pale, assumes a calm 
and death-like appearance. The smooth muscles are not usu- 
ally affected, but there is sometimes a relaxation of the sphinc- 
ters. There is paralysis of the motor reflex centres of the 
cord, as well as paralysis of the brain and depression of the 
medullary centres. Consciousness, sensation and most reflexes 
are abolished, and one of the last reflexes to disappear is the 
corneal. The pupils are contracted and do not respond to light, 
and the patient lies in a deep sleep. Snoring is apt to be pro- 
duced from the falling back of the tongue. The respiration 
becomes regular, but slower and shallower than before the 
inhalation was commenced. The pulse is generally somewhat 



CHLOROFORM. 89 1 

slow and weak, but regular, and the blood-pressure falls on 
account of the depression of the vaso-motor centre. Vomiting 
is a frequent occurrence, and dilatation of the pupil and in- 
creased pallor are generally indications of its approach. The 
body temperature invariably sinks in consequence of the less- 
ened muscular activity and to a less extent of the increased 
heat loss, and in prolonged anaesthesia the fall may be as much 
as 3 to 5 C. When the inhalation is discontinued, the patient 
again passes through a stage of excitement, which is generally 
much less violent but may be more prolonged than before. 
Usually in recovering from the anaesthesia he falls into a sleep 
which lasts several hours, but not infrequently there are dizzi- 
ness, nausea and vomiting for a considerable time. 

Third Stage. — The characteristic feature of this stage, which 
must be carefully guarded against, is progressive paralysis of 
the medulla. The surface is cold and covered with a clammy 
sweat, and the pupils become widely dilated, though at the last 
they may be either dilated or contracted. The faeces and urine 
are often passed involuntarily. The respiration grows irregu- 
lar, stertorous and labored. The pulse, now also irregular, 
becomes more and more slow and feeble, the blood-pressure 
falls to zero, and the heart, weakened and dilated, is finally 
arrested in diastole. 

There has been much discussion as to the cause of death in 
chloroform anaesthesia, and in 1889 the Nizam of Hyderabad 
appointed a special commission to investigate the question. 
After experimenting on over six hundred animals the commis- 
sion arrived at the conclusion that death is always due to arrest 
of the respiration. The criticism has been made that the altera- 
tions in the circulation produced by chloroform were not prop- 
erly appreciated by these investigators, or, at all events, were 
not sufficiently emphasized in their report, and in the United 
States it has generally been believed that death is from depres- 
sion of the heart. It may be stated that it is now generally 
accepted that the fatal effect of chloroform, as seen in its use 
as an anaesthetic in surgery, is due chiefly and in most instances 



892 PHARMACOLOGY AND THERAPEUTICS. 

to its action upon the circulatory system, and especially upon 
the heart itself. There seems to be no doubt of the fact that 
in general the mode of administration really determines the 
manner of its lethal action. Thus, a percentage of chloroform 
vapor so low as to be practically incapable of causing sudden 
death will, if the administration is maintained, finally bring 
about a fatal result from over-narcosis, and under these cir- 
cumstances it is almost invariably the case that death is due 
to failure of the respiration from paralysis of the respiratory 
centre in the medulla. Experiment has demonstrated that un- 
der the inhalation of very dilute chloroform the respiration 
always ceases several minutes before the heart, which continues 
to beat quite strongly for a short time and then grows rapidly 
weaker, and that as the concentration of the vapor is increased, 
the interval between the failure of the respiration and of the 
heart becomes shorter. When air saturated with chloroform 
vapor is inhaled, the interval between the two is so brief as to 
be inappreciable. The pulse, indeed, may be so weak as to be 
no longer perceptible before the respiration ceases, but if the 
movements of the heart be registered directly, it is usually 
found beating as long as the respiratory movements are car- 
ried on. From a practical point of view, it has been pointed 
out, it is of comparatively little importance whether there are 
a few fluttering beats of the heart after the last inspiration or 
not; the all-important question is whether the heart has been 
so injured as to be unable to carry on the circulation. Clinical 
experience has shown that it is the sudden administration of 
a high percentage of chloroform vapor which is responsible 
for most of the fatalities from this drug, and it is through its 
direct action on the heart that death is then caused. The car- 
diac muscle becomes paralyzed and more or less suddenly fails 
to be effective in maintaining the circulation, so that the blood- 
pressure falls rapidly. The heart is now incapable of empty- 
ing itself, and, the organ becoming distended with blood, its 
muscle, after a few slight fibrillar contractions, confined to 
the ventricular bases, finally stops acting. In some instances 



CHLOROFORM. 893 

in dogs, however, the heart has been found flabby and empty. 
The action of the respiratory system during this time must be 
regarded as for the most part secondary to the state of the 
circulation. When the blood-pressure has fallen considerably, 
the medullary centres become anaemic and the respiration fails. 
When the respiratory movements cease, the lesser, or pulmonic, 
circulation fails in consequence, and this embarrasses the heart 
still further, precipitating its distention and complete paralysis. 
Not only is the heart in a condition of paralytic distention, but 
the great vessels of the chest and abdomen are also distended 
with blood. In fact the vaso-motor paralysis of the vessels in 
the splanchnic system must always be taken into consideration 
in determining the factors which bring about a fatal issue. 

In its action on the central nervous system, as has been 
seen, chloroform affords an excellent illustration of the law of 
dissolution (see p. 737). Thus, the paralysis caused by it 
commences with the highest cerebral functions, those of self- 
control, and passes progressively downwards through the lower 
intra-cranial divisions. The spinal cord is affected before the 
medullary centres, which are the last portions of the cerebro- 
spinal axis to become paralyzed. In the recovery from chloro- 
form also the law of dissolution is illustrated, the lowest func- 
tions, such as muscular tone, being the first to reappear. The 
muscles and nerves are not affected by chloroform when in- 
haled. 

Metabolism. — A marked resemblance has been noted between 
the effects of chloroform on the metabolism and those of phos- 
phorus, and in both cases the formation of acid in excess in 
the tissues has been assigned as the cause of these effects. 
After the administration of chloroform either by inhalation or 
by the mouth both nitrogen and sulphur elimination is consid- 
erably augmented, indicating, it is believed, an increased de- 
struction of nitrogenous bodies in the tissues. The sugar of 
the blood has been found to be increased, and the glycogen of 
the liver diminished, or entirely absent. This is stated to be 
due to a specific action on the liver cells, which form glycogen 



894 PHARMACOLOGY AND THERAPEUTICS. 

into sugar much more rapidly than usual. Fatty degeneration 
of various organs, especially the liver, heart and kidneys, have 
been observed after the repeated administration of chloroform, 
and even after a single inhalation in some instances. If this 
process attains a certain degree of development it is found that 
it may lead to failure of the heart, but otherwise the tissues 
recover in a few days. Atrophic cirrhosis of the liver has been 
produced by the drug when given in small quantities for several 
months. Similar but less marked effects have been observed in 
the kidneys, spleen and lungs, and they are regarded as the 
result of a preliminary fatty degeneration of the parenchyma- 
tous cells. In addition to its action on the central nervous 
system, it must therefore be recognized that chloroform pro- 
duces marked changes in the processes of life and the nutrition 
of the different organs. 

Excretion. — Chloroform is excreted mainly by the lungs, but 
in small quantities may also escape in the urine, perspiration 
and milk. Some of the chloroform inhaled seems to undergo 
combustion in the body, and an increased acidity of the urine 
is attributed to hydrochloric acid formed by the combustion. 

Therapeutics of Chloroform. 
External. — The local application of chloroform has been 
found useful in a variety of conditions. In severe neuralgias 
its deep injection in the vicinity of the affected nerve is a valu- 
able resource. The official liniment is employed to relieve the 
pain of neuralgia, myalgia and chronic rheumatism and to re- 
duce chronic inflammations. Chloroform is also often used in 
liniments in association with camphor, tincture of aconite, or 
opium preparations. The following is highly recommended as 
a local anaesthetic: Chloroform, 12 c.c. (3 fl. dr.); camphor, 
2 gm. (30 gr.) ; tincture of aconite, 12 c.c. (3 fl. dr.) ; tincture 
of capsicum, 4 c.c. (1 fl. dr.) ; tincture of pyrethrum, oil of 
cloves, each 2 c.c. (J4 A- dr.). The camphor is first dissolved 
in the chloroform, and the oil of cloves and the tinctures are 
then added. For overcoming rigidity of the perineum in labor 



CHLOROFORM. 895 

the following application has been found useful: Chloroform, 
1 ; ether, 1 ; Cologne water, 8. The following combination has 
been recommended as an efficient anaesthetic spray for the per- 
formance of minor surgical operations: Chloroform, 37; men- 
thol, 4; ether, 56. An aching tooth may often be relieved by 
plugging it with cotton saturated with chloroform. Chloro- 
form is a good haemostatic, and applied upon lint or absorbent 
cotton, may be used to arrest superficial bleeding. The solution 
of gutta percha in chloroform has been employed as a protec- 
tive in small-pox and erysipelas, and has also been found use- 
ful in the treatment of fissured nipple, superficial burns, furun- 
cles, psoriasis and herpes zoster. A lotion containing chloro- 
form may be of service in urticaria. In irritable ulcer of the 
rectum and itching about the anus an ointment, such as that 
of zinc oxide, to which chloroform has been added in the pro- 
portion of 4 c.c. (1 fl. dr.) to 30 gm. (1 oz.), often affords great 
relief. Chloroform is an excellent antiseptic to preserve urine 
in transportation. .20 c.c. (3 Til) to 120 c.c. (4 fl. oz.) of urine 
is sufficient. The chloroform should be allowed to evaporate 
before testing the urine. 

Internal. — As chloroform disguises the taste of many nau- 
seous drugs, it is in common use for this purpose. Aqua 
Chloroformi is frequently employed as a vehicle and Spiritus 
Chloroformi as a flavoring agent. Like alcohol, the gastric 
effects of which are similar, chloroform is useful in some forms 
of dyspepsia, and in small doses it is sometimes given as a car- 
diac stimulant. Chloroform water, or a few drops of chloro- 
form taken upon sugar or in water, will often relieve vomiting 
when not due to inflammations of the stomach. Small doses 
of it, however, may prove of service for the vomiting and pain 
of gastric ulcer, especially when given in association with bis- 
muth preparations. The spirit of chloroform is used to arrest 
hiccough and also to relieve restlessness and irritating cough 
in pneumonia, pleurisy and bronchitis. A small quantity of it 
is a serviceable addition to expectorant mixtures when a neu- 
rotic element is present. 2 c.c. {]/ 2 fl. dr.), with an equal quan- 



896 PHARMACOLOGY AND THERAPEUTICS. 

tity of tincture of capsicum, in water, every half hour, hour, 
or two hours, has proved a very valuable hypnotic in delirium 
tremens with symptoms of depression and adynamia. The 
spirit of chloroform is sometimes given with advantage in com- 
bination with astringents and opium in diarrhcea, and is con- 
sidered especially useful in cholera morbus. In the treatment 
of true cholera no single remedy has been found more effica- 
cious than the empirical preparation known as chlorodyne (see 
p. 888). The following, taken as a draught, is said to be suc- 
cessful in the treatment of tape-worm: Chloroform, 4 c.c. (1 
fl. dr.) ; croton oil, .06 c.c. (1 "HI) ; glycerin, 30 c.c. (1 fl. oz.). 
Somnolence, so prolonged as to become serious, may, however, 
follow the administration of this prescription. 

Inhalation. — The inhalation of chloroform for anaesthetic 
purposes is principally employed for surgical operations, in 
biliary and renal colic, and in parturition. For painful de- 
livery but a small quantity is required, as it is given, not to 
produce unconsciousness, but merely to blunt the sensibility, 
and it is a matter of common observation that chloroform inhal- 
ation is borne better by women in labor than by any other class 
of subjects. Other purposes for which its inhalation is used 
are the relaxation of muscular spasm, as for the reduction of 
dislocations and hernias, and to relax the muscles for diagnostic 
reasons, as for making a thorough examination of fractures or 
of the abdomen, for the detection of malingering, etc. Finally, 
it is used for the relaxation of spasm in the convulsions of 
tetanus, hydrophobia and other affections. In certain anaes- 
thetic mixtures, which contain both ether and chloroform, the 
object is to obtain the anaesthetic effects of both these agents 
without the cardiac and respiratory depression of either. The 
best known of these is the A. C. E., which consists of 1 part 
alcohol (sp. gr. .838), 2 parts of chloroform (sp. gr. 1.497), an d 
3 parts of ether (sp. gr. .735). It is claimed that all of its 
three constituents volatilize from it at an equal rate, but as 
this has been found not to be the case (the ether evaporating 
first, the chloroform next, and the alcohol last), the advantages 



I 



CHLOROFORM. 897 

of the mixture would seem to be doubtful. While the A. C. E. 
enjoys considerable popularity in England, it has never been 
much liked in the United States. 

In the administration of chloroform careful attention must 
be paid to a number of points: 

1. The ansesthetizer must be skilled and give his attention 
exclusively to the production and maintenance of narcosis. 

2. False teeth should be removed from the patient's mouth, 
to prevent the possibility of their falling into the throat and 
choking him. 

3. No undigested food should be in the stomach; the patient 
should be fasting for at least four hours, if possible. If vomit- 
ing occurs, his head should be placed in such a position that no 
food can get into the larynx. 

4. The clothing must be loose enough to allow perfect free- 
dom of respiration. 

5. The head should be a little raised and the lower jaw held 
up, in order to prevent the tongue from falling back over the 
larynx. 

6. The chloroform must be pure. 

7. It should be given in such a way that the vapor may be 
thoroughly mixed with air in the proportion of about 5 to 95. 

8. The administration must be gradual, as " pushing " the 
anaesthetic is dangerous. 

9. The respiration should be watched with extreme care, as 
it appears to be a fact that gradual cardiac failure never takes 
place without producing respiratory changes from the first. A 
sudden cardiac arrest, as sometimes occurs in fatty heart, will 
not give warning either by the pulse or respiration. Unless, 
therefore, it is possible to have an extra assistant to watch the 
pulse, it seems advisable to neglect this, since a slighting of 
both objects in view is too often the result of dividing the 
attention. 

10. The operation should never be commenced until the stage 
of muscular relaxation has set in, when reflex action is to a 
large extent abolished. From neglect of this precaution many 

58 



898 PHARMACOLOGY AND THERAPEUTICS. 

lives have been lost, the heart being reflexly stopped by the 
stimulus of the knife; and it is a fact that most of the deaths 
from chloroform have occurred during slight operations, in 
consequence of the mistaken notion that because an operation 
is trivial it may be begun early. 

11. In operations about the mouth care must be taken to pre- 
vent the entrance of blood into the air-passages. 

12. The anaesthetic must be administered with special care in 
the old and in all cases where pulmonary disease is present or 
where the heart is feeble from any cause. It is contra-indi- 
cated in fatty heart. 

13. Special care is also called for when the operation neces- 
sitates awkward positions, and particularly those (such as the 
lateral position) in which the respiration is more or less inter- 
fered with. 

14. In consequence of the reduction of temperature caused by 
chloroform, the warmth of the patient must be seen to. 

15. Chloroform should never be administered without a hypo- 
dermatic syringe, in good order, being at hand. Amyl nitrite, 
ether and ammonia should be in readiness. 

16. Inasmuch as substances irritating to the lungs may be 
produced when the vapor of chloroform comes in contact with 
a naked flame (in the presence of which chloroform is decom- 
posed), good ventilation should be insisted upon when gas 
light must be employed. 

Should any signs of respiratory failure occur, artificial respi- 
ration must at once be commenced, the tongue being pulled 
forward by forceps to facilitate the ingress of air. The most 
efficient means of performing artificial respiration is the use 
of the Hoyt pump, each full stroke of the piston of which 
forces into the lungs, through an intubation tube inserted in 
the larynx, an amount of air corresponding with the normal 
inspiration. Other measures which may be employed are the 
flicking of the face and abdomen with wet towels, the adminis- 
tration of amyl nitrite by inhalation, and the hypodermatic in- 
jection of strychnine or ether. Brandy, or alcohol in other 



CHLOROFORM. 899 

form, should not be given. Galvanization over the cardiac 
area has been recommended, but it is probable that this is harm- 
ful rather than beneficial. The heart may be stimulated by 
large rectal injections of hot normal saline solution, or of hot 
decoctions of coffee, if at hand. One of the most efficient 
means of maintaining or restoring the action of the heart and 
the respiration is the Maas process. This consists of the ap- 
plication of a series of compressions of the chest over the heart 
sufficiently forcible to create an artificial carotid pulse, the com- 
pressions being made at the rate of 120 per minute. The object 
in view is to create an artificial circulation which may free the 
heart from distention and chloroformed blood, and raise the 
arterial tension so that the respiratory centre may be supplied 
with blood. If symptoms of improvement do not appear at 
once, the patient should be inverted, and this procedure is 
facilitated by hooking the knees over the table. It is claimed 
by some that inversion only adds to the danger, but there is a 
vast amount of clinical evidence going to show that it is of 
practical benefit, numerous instances being on record in which 
it was undoubtedly the means of saving the patient's life. The 
measures just mentioned should be maintained for hours, if 
necessary; but if in spite of them the heart utterly ceases to 
pulsate and the respiration completely fails, as a last resort 
the chest should be opened and cardiac massage practiced by 
the Kemp-Gardner method, artificial respiration at the same 
time being maintained and the prolonged infusion of hot normal 
saline solution employed. 

In spite of all care in administration and the observance of 
all precautions, one death takes place in about three thousand 
administrations. A painstaking series of experiments, how- 
ever, has afforded ground for the belief that chloroform is safe 
for the majority of cases, provided it be given by one skilled 
in its use, and who not only knows how to give it, but to detect 
signs of danger. The respiration should be especially watched, 
because, as has been mentioned, so soon as enough chloroform 
is used to endanger the circulation, the respiration will show 



900 PHARMACOLOGY AND THERAPEUTICS. 

some abnormality. In the healthy animal death is due to res- 
piratory failure, accompanied by circulatory depression. The 
latter itself may be severe enough to cause death, even if arti- 
ficial respiration be skillfully used. In most of the cases in a 
series of careful experiments on dogs respiratory failure oc- 
curred first, followed by heart failure. In several instances, 
however, heart and respiration failed -synchronously, and in one 
the heart stopped as if it had been stabbed. Chloroform may be 
chosen in hot climates ; when a large number of persons are to 
be anaesthetized; in Bright's disease; in aneurism; in marked 
atheroma of blood-vessels; in children or adults who already 
have bronchitis; and in persons who struggle violently. 

In 1901 a special committee was appointed by the British 
Medical Association to investigate chloroform in its therapeutic 
uses, the ultimate aim of the research being to determine the 
minimum dose of chloroform capable of producing adequate 
anaesthesia without endangering life. The first report of the 
committee was made in the summer of 1902 and the final report 
in that of 1903. In regard to the point whether the ordinary 
methods of administering chloroform are trustworthy and safe, 
the conclusion was reached that it is absolutely necessary to 
regulate the dosage of the drug, and that an apparatus is emi- 
nently desirable which will on the one hand permit the admin- 
istration of a definite dose capable of securing anaesthesia and 
on the other not endanger life. Furthermore, that safety de- 
pends upon dosage, that is, the proper percentage to be mixed 
with air. Concentration has been shown to be fatal, whereas it 
is maintained that a vapor below 2 per cent, is wholly safe, and 
that in most patients as low as 1 per cent, will maintain anaes- 
thesia. A further step was to determine with scientific accu- 
racy what the physical effects of various percentages were. 
Working with the isolated mammalian heart, the investigators 
found, among other points, that heart muscle takes up chloro- 
form from fluid circulating in the coronary vessels and that its 
lethal effects vary according to the fluid used. In diluted blood, 
for example, the chloroform gives less effect than in saline solu- 



CHLOROFORM. 9OI 

tion. With the increase of chloroform in the circulating fluid, 
more is taken up by the heart muscle, until finally toxic effects 
result. With weaker doses an equilibrium appears to be estab- 
lished between the chloroform-containing fluid and the heart 
muscle, so that at last no further effect upon the muscle mani- 
fests itself, in spite of the continued flow of the chloroform 
fluid. It was found that under toxic doses the ventricle is 
paralyzed in its action before the auricle. The experiments go 
to show the extreme importance of restricting the dosage of 
chloroform to relatively weak percentages, and that the size 
of the dose circulating in fluid through the heart is the im- 
portant element, rather than the length of time during which 
it circulates. Higher concentrations than 2 per cent, should be 
looked upon as potentially dangerous, since their tendency is, 
other things being equal, to paralyze the heart muscle. The 
prolongation of the anaesthesia with a dilution under this per- 
centage is not to be regarded as dangerous, although naturally 
individual susceptibility must be taken into account, and, as 
usual, arguments drawn from animals cannot be forthwith and 
without modification applied to man. It will be observed that 
these experiments in a measure controvert the idea that chloro- 
form has a cumulative effect upon the heart. As they were 
made upon the isolated heart, they would appear to leave unas- 
sailed the position that the use of low percentages, if continued 
sufficiently long, may bring about a fatal result by inducing 
paralysis of the respiratory centre. 

ETHER. 

-SJTHER.— Ether. (Sulphuric Ether. Ethylic Ether. Ethyl Oxide.) 
Dose, 1 c.c; 15 TO,. 

Preparations. 

1. Oleum uEthereum. — Ethereal Oil. 

2. Spiritus Athens. — Spirit of Ether. Dose, 4 c.c; 1 fl. dr. 

3. Spiritus ^Etheris Compositus. — Compound Spirit of Ether. 
(Hoffmann's Anodyne.) Dose, 4 C.C.; 1 fl. dr. 



g02 PHARMACOLOGY AND THERAPEUTICS. 

Action of Ether. 

External. — By its rapid evaporation when applied to the skin, 
ether produces a sensation of cold, and the part becomes 
blanched from the resulting contraction of the blood-vessels. 
When it is used in the form of a spray, this action is intensified, 
and marked local anaesthesia is caused. If, however, evapora- 
tion is prevented, or the ether is rubbed in, an irritant effect is 
produced, though less pronounced than in the case of alcohol 
or chloroform. 

Internal. — In the mouth and stomach its effects are similar 
to those of alcohol and chloroform. It is a very prompt car- 
minative, causing increased secretion of the glands and dilata- 
tion of the gastric vessels. By reflex action it also at once 
stimulates the heart, increasing the force and frequency of the 
pulse and raising the blood-pressure, and at the same time 
excites respiration. It is absorbed rapidly and is not only a 
quickly acting diffusible stimulant, but also an anti-spasmodic. 

Nervous System. — The action on the central nervous system 
in general resembles that of chloroform, but in some important 
particulars there is a difference. The respects in which the 
two differ, when given for anaesthetic purposes, are somewhat 
as follows: 

i. Chloroform acts 36 to 48 times as powerfully as ether in 
paralyzing the heart. The pulse is not nearly so much affected 
by ether as by chloroform; while it may be somewhat slower 
than usual, it is full and strong. 

2. Chloroform is 3 to 3^2 times as depressant as ether to the 
medullary centres and the rest of the central nervous system. 

3. Anaesthesia is produced with greater difficulty, more 
slowly, and often less powerfully with ether than with chloro- 
form; consequently, the stage of excitement is usually more 
marked and prolonged, and naturally attended with more 
struggling. 

4. It is necessary to give the ether in much more concen- 
trated form in order to produce narcosis — about 70 per cent, 
of ethereal vapor to 30 per cent, of air. 



ETHER. 9O3 

5. Consequently, it is much more difficult to administer than 
chloroform. 

6. Also it produces more irritation of the respiratory pass- 
ages. 

7. Ether is much more likely to irritate the kidneys. 

8. Chloroform is much more agreeable to inhale. Its odor 
and taste are sweet and pleasant, and it causes less irritation 
and less feeling of suffocation. 

9. Ether is eliminated more slowly, and the odor therefore 
lingers about the person for some time. 

10. On account of its inflammability, ether is dangerous in 
the vicinity of a naked flame or where the actual cautery is 
to be used. When artificial light, other than the incandescent 
electric, must be employed, the lamp should always be adjusted 
above the patient, since the ether vapor is heavier than air. 

Kidneys. — From experimental researches it appears that in 
the dog, at least, ether anaesthesia has for some as yet unex- 
plained reason a specific action upon the kidney, consisting of 
a constriction of the arterioles of the organ. This is entirely 
independent of any change in the general arterial circulation, 
since it is found from the carotid tracings that the blood- 
pressure is raised from the beginning. The vascular contrac- 
tion in the kidney has a damaging effect upon the renal secre- 
tory cells, similar to that which follows clamping the renal 
artery; the kidney shrinks in bulk, and as the etherization 
progresses to deep narcosis there is a diminished secretion of 
urine, marked albuminuria, hematuria, and, finally, suppression. 
It would seem probable that in man a corresponding action is 
elicited. 

Excretion. — So far as known, ether appears to be excreted 
only by the lungs. 

Therapeutics of Ether. 
External. — The pouring of ether on the scalp sometimes 
promptly arrests headache. An ether spray may be used in 
superficial neuralgia, where the benumbing of the nerve some- 



9O4 PHARMACOLOGY AND THERAPEUTICS. 

times effects a permanent cure. It is also employed at times 
to produce local anaesthesia (by the cold resulting from the 
evaporation of the ether), for small operations, and it is par- 
ticularly useful where thoracentesis or paracentesis abdominis 
is to be performed, or a simple incision made. As a rule, how- 
ever, the hardness of the tissues caused by it is a serious ob- 
jection as regards operations, while the subsequent reaction is 
liable to produce considerable tingling and pain, as well as 
oozing of blood from the wound. In any case where such local 
anaesthesia is used, the cold produced should not be intense 
enough to actually freeze the tissues, as this is apt to render 
the healing slow. Since it dissolves fat from the skin, ether may 
also be employed as a detergent before operations, the part to 
be operated on being washed with it after soap has been used. 
Ether being a good solvent of the active principles of many 
drugs and also of sebaceous matter, it has been strongly recom- 
mended as a menstruum for various remedies to be applied to 
the skin. The ether-spray has sometimes been successfully 
used in strangulated hernia, and its application to the spine has 
been followed by good results in some cases of chorea. 

Internal. Stomach. — Ether is very useful in colic and some 
forms of dyspepsia. Small doses of Hoffmann's anodyne, which 
may be administered in camphor water, are efficient in expel- 
ling flatus from the stomach and are often of service in gastral- 
gia and sick headache. A few drops of ether, added to cod- 
liver oil, render it more tolerable to the stomach and facilitate 
its digestion and absorption, probably by increasing the secre- 
tion of pancreatic juice. 

Heart. — On account of the rapidity of its action, ether is a 
cardiac stimulant of great value, and it is frequently employed 
in fainting, palpitation and heart-failure. According to cir- 
cumstances, it may be given either by the mouth or by hypo- 
dermatic injection. The dose for the latter purpose is 0.60 to 
1 c.c. (10 to 15 HI). It is also a useful anti-spasmodic in 
asthmatic attacks. 



ETHER. 905 

Inhalation. — Ether is administered as a general anaesthetic 
for the same purposes as chloroform. On account of its greater 
safety, it is more commonly used in the United States. Some 
accidents with chloroform are no doubt due to carelessness, on 
account of the great facility with which it can be administered, 
but granting this, there can be no question that chloroform, as 
might be supposed from the points in which its action differs 
from that of ether, is the more dangerous agent of the two. 
From the published statistics it would appear that the imme- 
diate mortality with chloroform is from three to five times as 
great as with ether. The difference in the concentration re- 
quired to produce anaesthesia and that which will cause serious 
impairment of the heart's action, or which will stop the respira- 
tion, is very much smaller in the case of the one than of -the 
other. Hence the preference should be given to ether except 
when this is specifically contra-indicated, as in bronchitis, 
nephritis, etc. From clinical observation, as well as experi- 
mental research, it is clear that ether has a special tendency 
to produce kidney trouble, and as a rule, therefore, it had bet- 
ter be avoided when renal disease is present, and particularly 
when with this there is a tendency to pulmonary oedema. If 
employed at all, it should be administered with the greatest 
caution to those suffering from the various forms of acute or 
chronic kidney disease, or renal insufficiency from any cause. 
Both ether and chloroform have been shown to be highly dan- 
gerous in cases of diabetes. Much attention has of late been 
directed to fatalities occurring as sequelae of surgical anaesthe- 
sia : in the case of chloroform more particularly in consequence 
of fatty degeneration of the heart and kidneys or of diabetic 
coma, and in that of ether from uraemia and from bronchitis, 
pneumonia and pulmonary oedema, especially in the subjects of 
nephritis. In a considerable number of instances death from pul- 
monary oedema with bronchial effusion and aspiration pneumonia 
has occurred in the course of a few days after etherization. It 
is claimed by many that these post-anaesthesia deaths are decid- 
edly more frequent after ether than after chloroform, and, in 



g06 PHARMACOLOGY AND THERAPEUTICS. 

fact, that their number is large enough to bring the total mor- 
tality from ether, immediate and secondary, quite up to or even 
beyond that of chloroform. Some surgeons, it may be stated, 
who formerly used ether almost exclusively, believing that if 
a fair estimate were made the fatal uraemias and pneumonias 
depending on ether, if properly credited to it, would reverse 
the record as it stands at present, are now chiefly employing 
chloroform. As it is very difficult, however, to distinguish 
between the results of the anaesthetic and the ordinary forms 
of disease, no very reliable statistics are as yet available in 
regard to the point at issue. The practice is now quite common 
of commencing ether anaesthesia with the preliminary inhala- 
tion of nitrous oxide gas, and in this way the disagreeableness 
of ether to the patient may be largely obviated and a more 
rapid and satisfactory narcosis secured. For the nausea and 
vomiting sometimes caused by ether the administration of I 
gm. (15 gr.) of sodium bromide has been recommended. 

AETHER ACETICUS.— Acetic Ether. (Ethyl Acetate.) Dose, 1 
c.c; 15 TTt. 

Action of Acetic Ether. 
It resembles ether in its carminative, stimulant and anti- 
spasmodic properties, but as it is less volatile, its action is 
less prompt and more prolonged, and it is more irritating to 
the skin. While its inhalation will produce general anaesthesia, 
its effect in this respect is too slow for practical purposes. 



Therapeutics of Acetic Ether. 
On account of its agreeable odor and taste it is combined 
with other carminatives as a stimulant and antispasmodic. It 
is employed as an ingredient of Cologne water, and is some- 
times applied externally with friction, as a resolvent and for 
the relief of rheumatic and other pains. The inhalation of its 
vapor allays laryngeal and bronchial irritation, and may also 
be found useful in nervous cough. 



ETHYL BROMIDE. 9O7 

Unofficial Preparation. 
jEthylis Bromidum. — Ethyl Bromide. (yEther Bromatus. 
Hydrobromic Ether.) 

Action of Ethyl Bromide. 
Ethyl Bromide was introduced to the profession in 1880 as 
the most agreeable and rapid anaesthetic. 

Therapeutics of Ethyl Bromide. 

Several fatal cases having been reported, its use was aban- 
doned. Recently, however, the inhalation of ethyl bromide, 
when pure, has been recommended in doses of from 12 c.c. ; 3 
fl. dr. (child of two years), to 24 c.c; 6 fl. dr. (adult), for 
surgical anaesthesia. The following precautions should be ob- 
served: Food, even a glass of milk, is absolutely forbidden on 
the day of operation. A mask is to be employed, and this 
should perfectly cover the mouth and nose, so that no air is 
allowed to enter. The entire dose should be given at once. 
When narcosis is complete, the mask should be removed, and 
under no consideration be re-applied. The administration must 
not be prolonged over one minute. Sleep is obtained in from 
twenty to thirty seconds, and lasts from two to three minutes, 
sometimes longer. The contra-indications to its use are dan- 
gerous lesions of heart, lungs, or kidneys. 

Somnoform, which is a mixture of ethyl bromide, 5 parts; 
ethyl chloride, 60 parts ; and methyl chloride, 35 parts, has been 
highly recommended as an anaesthetic for small operations, 
though a number of surgeons have failed to find that it pos- 
sesses advantages over the ordinary anaesthetics in use. It has 
now been tried to a considerable extent, especially in dentistry, 
as a substitute for nitrous oxide. It acts promptly, and if it 
is inhaled for from fifty seconds to two minutes does not give 
rise to nausea and vomiting or other unpleasant results. It is 
said to induce complete relaxation of the muscles, without 
cyanosis. A mask should be employed for the inhalation. A 
single dose of somnoform is 5 gm. (75 gr.), and this is supplied 



PHARMACOLOGY AND THERAPEUTICS. 



in a graduated glass. In prolonged operations it is necessary 
to repeat the dose several times. Mixed anaesthetics are much 
more commonly resorted to in England and on the Continent 
than in America. 

PENTAL. 

Unofficial Preparation. 
Pentalum. — Pental. (Trimethylethyhene.) 

Action of Pental. 
Pental is an anaesthetic, the equal of nitrous oxide in rapidity 
of action and perhaps safety, but superior to it in its more pro- 
longed action and in having no unpleasant after-effects. Even 
when insensibility to pain is reached, consciousness is retained 
sufficiently to respond to commands. The stage of exhilaration 
is seldom present. The drug does not lose its effect by repeated 
inhalations. It differs from chloroform in that it acts more 
promptly, and has no evil after-effects ; from ethyl bromide, in 
that it is somewhat slower in its action, but is more lasting in 
its effects, and can be prolonged as may be necessary; from 
nitrous oxide, in its freedom from unpleasant effects. 

Therapeutics of Pental. 
It may be used for short operations, but it is not absolutely 
safe, as was at one time claimed. 

Division XL — Drugs Acting on the Organs of Generation. 

A. Aphrodisiacs. — These are substances which increase sex- 
ual desire and power. They are supposed to act by stimulating, 
directly or reflexly, either the cerebral or spinal genital centre. 
The latter has been located in the lumbar portion of the cord, 
and irritation of it induces erection. It is conceivable that it 
may be excited by afferent impulses conveyed to it from various 
parts of the parts, but especially from the cerebrum and the 
genital organs. Its activity appears to be largely dependent 






DRUGS ACTING OX ORGANS OF GENERATION. 909 

upon the condition of the general health, and hence tonics and 
all measures promoting the bodily nutrition may act as indirect 
aphrodisiacs. 

The following drugs are known as aphrodisiacs ; their mode of action 
in this regard is not very clearly understood. 



(1) Strychnine. 

(2) Cantharides. 

(3) Alcohol. 

(4) Cannabis Indica. 



(5) Camphor. 

(6) Phosphorus. 

(7) Damiana. 



Strychnine probably acts by raising the tone of the spinal 
centres, cantharides. camphor and damiana through reflex irri- 
tation from the urethral mucous membrane, alcohol and can- 
nabis indica by their effect on the imagination, and phosphorus 
by improving the general condition, especially in chronic ner- 
vous exhaustion. 

B. Anaphrodisiacs. — These are remedies employed to dimin- 
ish sexual desire. They are supposed to act by decreasing the 
local circulation, by lessening the excitability of the nerves of 
the genital organs, or by depressing the genital centres. Most 
of them, it may be said, are probably effective by diminishing 
or removing some source of irritation which is reflexly pro- 
ducing an aphrodisiac effect. 

Drugs used as anaphrodisiacs are — 

(1) Bromides. (5) Hyoscyamus. 

(2) Potassium iodide. (6) Stramonium. 

(3) Opium. (7) Digitalis. 
(1) Belladonna. (8) Purgatives. 

Local applications of ice, or cold baths, are sometimes of 
service as anaphrodisiacs. 

C. Ecbolics or Oxytocics are remedies which during or im- 
mediately after parturition increase uterine action. 



9io 



PHARMACOLOGY AND THERAPEUTICS. 



They are — 

(1) Ergot. 

(2) Cotton root bark. 

(3) Hydrastis. 

(4) Caulophyllum. 

(5) Savin. 



(6) Rue. 

(7) Cimicifuga. 

(8) Quinine. 

(9) Powerful purgatives. 



Of these ergot is by far the most important. Occasionally some of 
these drugs will act upon the gravid uterus to produce abortion before 
parturition has begun. Most of them have been used for this purpose 
with criminal intent. 

D. Emmenagogues are substances used to increase the men- 
strual flow. Diminution of the menstrual flow is a symptom 
of quite a large number of conditions ; so that the various drugs 
which are beneficial in any of these are indirect emmenagogues. 
Certain substances, however, appear to have a special action in 
increasing the menstrual flow. They are — 



(1) All Ecbolics. 

(2) Manganese salts. 

(3) Asafetida. 

(4) Apiol. 

(5) Myrrh. 



(6) Guaiac. 

(7) Cantharides. 

(8) Borax. 

(9) Tansy. 



Among the many indirect emmenagogues the commoner are purga- 
tives, iron, cod-liver oil, and strychnine, which act by improving the 
general health. Hot foot- or hip-baths, especially if mustard be added, 
often aid the onset of menstruation. 

E. Substances which depress Uterine Action. — These are em- 
ployed to diminish or abolish the contractions of the gravid 

uterus. 



They are — 

(1) Bromides. 

(2) Opium. 

(3) Hydrated chloral. 

(4) Viburnum. 



(5) Cannabis Indica. 

(6) Chloroform. 

(7) Antimony and potassium 

tartrate. 



PHOSPHORUS. 9I I 

F. Drugs acting on the Secretion of Milk. 
Galactagogues are drugs which increase the secretion of 
milk. The most prominent are: 

Pilocarpus, Leaves of Ricinus communis, and Alcohol. — Of these 
pilocarpus is the most powerful, but its effects soon pass off. The 
leaves of the castor-oil plant are used, applied as a poultice, while a 
decoction or the fiuidextract of them is given internally at the same 
time. Alcohol has but a feeble effect, although the malt liquors have 
considerable reputation as galactagogues. The secretion is very depend- 
ent on the condition of the system at large ; so that the best means of 
securing an abundant flow of milk is to maintain the general health. 

Antigalactagogues are drugs which decrease the secretion of 
milk. 

Belladonna, either given internally or applied locally, is usually 
efficient for this purpose, by paralyzing the nerves of the mammary 
gland. 

The following drugs are excreted by the milk, and are therefore 
taken in by the nursing child : — Oil of anise, oil of dill, garlic, oil of 
turpentine, oil of copaiba, and probably all volatile oils, sulphur, rhu- 
barb, senna, jalap, scammony, castor oil, opium, iodine, indigo, anti- 
mony, arsenic, bismuth, iron, lead, mercury, zinc and potassium iodide. 
It is evident, therefore, that these remedies must be administered with 
care to the mother ; for example, copaiba or turpentine will make the 
milk so unpleasant that the child will not take it. Such of the above 
list as are purgatives, when given to the mother, may cause diarrhoea 
in the child. Opium should not be given in large doses to the mother. 
On the other hand, mercury, arsenic, and potassium iodide may be 
administered to the child by being given to her. 

A. Aphrodisiacs. 
PHOSPHORUS. 
PHOSPHORUS.— Phosphorus. Dose, 0.Q005 gm. (0.5 milligm.); 

Preparation. 
Pilulae Phosphori. — Pills of Phosphorus. Dose, 1 pill. 

Unofficial Preparations. 
Spiritus Phosphori (U. S. P., 1890). — Spirit of Phosphorus. 
(Tincture of Phosphorus.) Dose, .50 to 2.50 c.c; 8 to 40 TT\,. 



912 PHARMACOLOGY AND THERAPEUTICS. 

Oleum Phosphoratum (U. S. P., 1890). — Phosphorated Oil. 
Dose, 0.05 to 0.30 c.c; 1 to 5 Hi. 

Elixir Phosphori (U. S. P., 1890). — Elixir of Phosphorus. 
Dose, 2.0 to 10 c.c.; y 2 to 2 l / 2 fl. dr. 

Action of Phosphorus. 
Phosphorus has a specific action on bones, and especially 
those of young animals which are still growing. Under the 
influence of . minute quantities the cancellous tissue tends to 
become compact, and there is a deposition of true bone of nor- 
mal composition. This effect is attributed to the phosphorus 
acting as an irritant or stimulant to the bone-forming cells, and 
arsenic also appears to produce it to some extent. Small doses 
of phosphorus generally increase the number of red blood- 
corpuscles in man. Unless taken in a state of fine division or 
dissolved in oil, it is absorbed with difficulty, because of its 
insolubility in the fluids of the body and of its slow volatiliza- 
tion. The great mass of it, if finely divided, is absorbed un- 
changed and exists in the blood as phosphorus, and its action 
is due to this element rather than to its compounds. But little 
is known of its fate in the body. It is thought that a portion 
may perhaps be oxidized to phosphoric acid, and some of it is 
stated to be eliminated by the lungs, while some is excreted in 
the urine in obscure organic combinations. Phosphorus dimin- 
ishes tissue waste, decreasing the elimination of urea and of 
carbon dioxide. As it is found as a necessary element in the 
nervous system, its action is that of a stimulant to its growth. 
Further details of its action are given under Toxicology. 

Therapeutics of Phosphorus. 
The best known liquid preparation is Thompson's solution : 
Phosphorus, 1; absolute alcohol, 300; glycerin, 720; and spirit 
of peppermint, 40; dose, 1.20 to 4 c.c. (.J to 1 fl. dr.). Phos- 
phorus is especially indicated in osteomalacia, in rickets, and 
in cases of ununited fracture. Without doubt it promotes 
calcareous deposit in the healing of fractures. It is of value 



PHOSPHORUS. 913 

in convalescence from exhausting diseases, in nervous exhaus- 
tion, in neuralgia when dependent upon debility, in alcoholism, 
in sexual exhaustion, and in various suppurative affections. 

TOXICOLOGY. 

Acute Poisoning. — As phosphorus is quite accessible in the form 
of matches or vermin paste, poisoning by it, either accidental or suici- 
dal, is not uncommon. 

Symptoms. — For some hours no effect is observed. Then there is a 
burning pain in the abdomen, with nausea. The vomit has the char- 
acteristic garlicky odor of phosphorus and is luminous if heated with 
sulphuric acid. There is more or less general depression, and this 
may amount to fatal collapse. Usually, however, the patient recovers 
from these effects and appears to be quite well for two, three or four 
days, when he again begins to suffer from vomiting, and the vomited 
matter is often bloody. There are also abdominal pain, distention and 
tenderness, and sometimes diarrhoea, and the stools may contain blood. 
With these symptoms there occurs jaundice, which soon becomes very 
marked, and the area of liver dullness is increased in consequence of 
fatty changes occasioned in that organ. The emesis, abdominal pain, 
and diarrhoea are explained by the same cause, the epithelial cells of 
the stomach and intestine undergoing fatty degeneration. There is 
considerable muscular weakness and pain, together with a small and 
quick pulse and general prostration. Slight fever is sometimes ob- 
served, but the temperature is often lowered in the later stages, 
though the patient usually complains of intense thirst. There is likely 
to be a garlicky odor to the breath. Haemorrhages may occur in many 
different situations, and the immediate cause of these is fatty degener- 
ation of the muscular coat of the smaller arteries throughout the body. 
The urine also may contain blood, as well as bile, leucin and tyrosin 
crystals, albumin, and an abnormal amount of ammonia. Peptone is 
sometimes excreted, and the phosphates and sulphates are apt to 
be increased from the augmented tissue-waste. The chlorides are much 
diminished, in consequence of the patient's taking little or no food. 
Sarcolactic acid appears in considerable quantity in the urine, and is 
sometimes accompanied by some sugar. The acid is regarded as diag- 
nostic of phosphorus poisoning. This condition lasts from five to eight 
days, when the patient usually dies of heart failure, as a result of fatty 
degeneration of the cardiac muscle from the direct action of the poison 
upon it. Towards the last convulsions and coma may occur, and these 

59 



9I4 PHARMACOLOGY AND THERAPEUTICS. 

are regarded as a result of disordered metabolism, rather than due to 
any direct influence on the central nervous system. Even when the 
symptoms are very severe, however, recovery is possible. With phos- 
phorus burns none of the symptoms of phosphorus poisoning are pre- 
sented. 

Post-mortem. — As might be supposed from the above description, 
wide-extended fatty degeneration is a prominent feature of the post- 
mortem findings, and in this respect phosphorus resembles arsenic, anti- 
mony and chloroform. This pathological change is most marked in the 
liver, but numerous fat globules are observed in the cells of many other 
organs, notably the kidneys and the gastric and intestinal glands, and also 
in the muscle fibres of the heart, stomach, intestines, smaller arteries, 
and often of the skeletal muscles. As to whether this fat is formed by 
the degeneration of the protoplasm of the cells in which it is found, 
or whether it is carried from other parts of the body and simply de- 
posited in these cells, is as yet undetermined, but the weight of evidence 
appears to be decidedly in favor of the latter view. Another char- 
acteristic feature is the appearance of numerous haemorrhages and 
ecchymoses. In addition to the fatty degeneration of the muscular 
coats of the arteries referred to, it is probable that the absence of 
clotting in the blood, due to the changes in the intestine and liver, 
which interfere with the formation of fibrin, is a factor in the causation 
of these. It has been noted that if the patient lives long enough, 
there may be a diminution in the size of the liver, and altogether the 
effects of phosphorus poisoning present a considerable resemblance to 
those of acute yellow atrophy of this organ. 

Treatment. — As phosphorus is absorbed from the alimentary canal 
comparatively slowly, an attempt should be made in the early stages to 
remove it by emetics or the washing out of the stomach and by purges. 
Afterwards the object is to oxidize the phosphorus. Formerly copper 
sulphate was much lauded as an antidote, but recent researches appear 
to prove that it is itself a dangerous poison. Experiments on dogs 
have shown that old oil of turpentine, which contains oxygen, if ad- 
ministered before the poison is absorbed, is an antidote. Ordinary oil 
of turpentine, however, is worse than useless, for as phosphorus is 
soluble in oils, we simply aid in its absorption by giving any oily or 
fatty substances. It is stated that only old, ozonized French oil of 
turpentine is really antidotal in its influence. Repeated and free in- 
halations of oxygen have been used, and this suggests that hydrogen 
dioxide may be efficacious when given by the mouth. Potassium per- 
manganate has also been advised for the purpose of oxidizing the 



PHOSPHORUS. 915 

phosphorus. In the secondary stage alkalies are recommended in order 
to neutralize the excess of sarcolactic acid formed in the tissues. 

Chronic Poisoning. — From the fact that the red or non-poisonous 
phosphorus is now generally employed in match factories, chronic 
poisoning, which was formerly frequently met with in those who worked 
among phosphorus fumes, has become a very rare occurrence. Such 
poisoning manifests itself in gastro-intestinal irritation and a peculiar 
necrosis of the jaws. The latter, which usually has its starting-point 
in carious teeth, begins with salivation and suppurative ulceration of 
the gums ; after which there results a profound periostitis, involving 
the whole jaw. The lower jaw is more often affected. Phosphorus 
necrosis must be treated surgically on the same principles as other 
necroses. The diseased bone readily becomes the seat of tuberculous 
deposit, and sufferers from phosphorus necrosis not infrequently die 
from general tuberculosis. 

1. CALCII HYPOPHOSPHIS.— Calcium Hypophosphite. Dose, 
0.500 gm. (500 milligm.) ; 7V 2 gr. 

2. SODII HYPOPHOSPHIS.— Sodium Hypophosphite. Dose, 1 
gm.; 15 gr. 

3. POTASSII HYPOPHOSPHIS. —Potassium Hypophosphite. 
Dose, 0.500 gm. (500 milligm.); iy 2 gr. 

4. FERRI HYPOPHOSPHIS.— Ferric Hypophosphite. Dose, 0.200 
gm. (200 milligm.); 3 gr. 

5. MANGANI HYPOPHOSPHIS. — Manganese Hypophosphite. 
Dose, 0.200 gm. (200 milligm.) ; 3 gr. 

6. ACIDUM HYPOPHOSPHOROSUM.— Hypophosphorous Acid. 

7. ACIDUM HYPOPHOSPHOROSUM DILUTUM.— Diluted Hy- 
pophosphorous Acid. Dose, 0.5 c.c; 8 Tr\,. 

Preparations. 

1. Syrupus Hypophosphitum. — Syrup of Hypophosphites. 
Dose, 8 c.c; 2 fl. dr. 

2. Syrupus Hypophosphitum Compositus. — Compound Syrup 
of Hypophosphites. Dose, 8 C.C.; 2 fl. dr. 

3. Emulsum Olei Morrhuae cum Hypophosphitibus. — Emul- 
sion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.; 
2 fl. dr. 



gi6 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Sympus Hypophosphitum cum Ferro (U. S. P., 1890). — 
Syrup of Hypophosphites with Iron. Dose, 4 to 8 C.C.; 1 to 2 
fl. dr. 

Zinci Phosphidum (U. S. P., 1890).— Zinc Phosphide. Dose, 
0.006 to 0.02 gm.; ^ to 1 gr. 

Action of Ferric, Calcium, Sodium, Potassium and Man- 
ganese Hypophosphites. 
The hypophosphites were introduced under the supposition 
that they exert some special influence on nutrition. Practically 
the whole of the hypophosphite administered can be recovered 
from the urine, showing that they are not oxidized to phos- 
phates in the tissues, as was formerly believed to be the case. 
So far as investigations regarding their effects on nutrition has 
gone, no evidence has been furnished, according to the best 
authorities, that they have any further action than the other 
indifferent salts, such as the chlorides. The chief effect of 
ferric hypophosphite is regarded as undoubtedly due to its me- 
tallic iron. 

Therapeutics of Ferric, Calcium, Sodium, Potassium and 
Manganese Hypophosphites. 

Notwithstanding the unsatisfactory experimental evidence of 
their value, these drugs are extensively used in cachectic con- 
ditions, especially tuberculosis, and are the basis of a large 
number of proprietary preparations. 

Following Churchill, they should be of chemical purity, neu- 
tral in reaction; the presence of free alkali or alkaline carbon- 
ates quickly giving rise to an atonic dyspepsia. The official 
syrups of the hypophosphites are faulty in that each salt 
has a peculiar property, for the final result is due to the 
hypophosphite and its beneficial effect upon nutrition. In the 
early stages of phthisis (infiltration) the sodium salt should be 
administered and the sodium salt alone ; if excavation is present 
the calcium salt is indicated, and that alone, provided that it 



CALCIUM HYPOPHOSPHITE. 917 

does not too suddenly check expectoration; when the sodium 
salt should be resumed. 

The potassium salt is a valuable expectorant in chronic bron- 
chitis; but it has a very limited usefulness in phthisis. The 
hypophosphites, when administered intelligently, will improve 
nutrition and relieve some of the symptoms of phthisis. If 
administered in too large doses, or simultaneously with other 
remedies, as arsenic, stimulants, strychnine, or cod-liver oil, 
they are likely to produce headaches and dyspepsia, and fail 
to cause improvement. The objection to the official syrups, 
namely, the use of the salts in combination, applies to nearly 
all of the proprietary preparations, most of which contain im- 
pure salts, contain a low percentage of hypophosphites, and 
are not scientific combinations. The syrup of hypophosphites 
with iron is valuable as a reconstructive. Zinc phosphide is 
believed to have the same physiological and therapeutical effects 
as phosphorus. 

Unofficial Preparations. 
Calcii Glycerophosphas. — Calcium Glycerophosphate. Dose, 
0.30 to 1 gm.; 5 to 15 gr. 

Sodii Glycerophosphas. — Sodium Glycerophosphate. Dose, 
0.6 to 2 C.C.; 10 to 30 TTt, usually hypodermatically. 

Action of the Glycerophosphates. 
The administration of these substances has been found to 
increase the solids of the urine, the urea, the carbon dioxide 
and sulphur oxidation coefficient, the chlorides, sulphates, lime, 
magnesia and potash, with but little effect on uric acid. They 
improve the nutrition of all organs, but more particularly that 
of the nervous system. Potassium, Lithium, Iron and Mag- 
nesium Glycerophosphates (none of them official) are also 
prepared. 

Therapeutics of the Glycerophosphates. 
Inasmuch as the urine of neurasthenics contains relatively 
large amounts of incompletely oxidized phosphorus, especially 



91 8 PHARMACOLOGY AND THERAPEUTICS. 

in the form of glycerophosphoric acid, the effort was made to 
replace this loss by the introduction of phosphorus into the 
organism in a form approaching, as nearly as is possible, that 
in which it exists in the nervous system. The indications for 
the glycerophosphates are conditions of nerve depression. If 
given subcutaneously they are at least as efficacious as testicular 
fluid (q. v.), which owes its activity to its contained organic 
phosphates, and possess the advantage of more accurate dosage. 
They are useful in various neuralgias, as sciatica, tic doulou- 
reux, Addison's disease, and in the symptom-complex, known as 
neurasthenia. Chlorosis, albuminuria, phosphaturia and anaemia 
(the latter by the iron salt) have been benefited. In diabetes the 
general condition improves and the amount of sugar may dimin- 
ish. In various diseases of the bones, such as rachitis, osteo- 
malacia and tuberculous affections, the lime and magnesium salts 
are indicated, though, as has been stated, the value of lime salts 
in these has been seriously disputed {see p. 217). The reme- 
dies should not be expected to rejuvenate senility, but are use- 
ful, even if slowly acting, adjuncts to the systemic treatment 
of an impaired nervous system. 

DAMIANA. 

Unofficial Preparations. 

Damiana. — Damiana. Dose, 15 to 30 gm.; y 2 to 1 oz. 

Fluidextractum Damianae. — Fluidextract of Damiana. Dose, 
2 c.c; y 2 fl. dr. 

Action of Damiana. 
Damiana has enjoyed considerable reputation as a remedy 
for sexual atony. Some observers believe it to be only tonic. 

Therapeutics of Damiana. 
It is best administered as a fluidextract, in the dose of 2 
c.c. {J/2 A. dr.), and in conjunction with remedies of this class 
of established worth. 



ERGOT. 9 1 9 

C. Ecbolics. 
ERGOT. 
ERGOTA.— Ergot. (Ergot of Rye.) Dose, 2 gin.; 30 gr. 

Preparations. 

1. Extractum Ergotae. — Extract of Ergot. (Ergotin.) 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

2. Fluidextractum Ergotae. — Fluidextract of Ergot. Dose, 
2 c.c; 30 m.. 

3. Vinum Ergotae. — Wine of Ergot. Dose, 8 c.c; 2 fl. dr 

Action of Ergot. 
The effects of cornutine are quite distinct, in some respects 
at least, from those of the other constituents of ergot. Like 
picrotoxin, it produces a stimulation of the medulla oblongata, 
followed by paralysis. A rise in blood-pressure results from 
the stimulation of the vaso-constrictor centre. While the other 
medullary centres, the salivary, vagus, vomiting, respiratory, 
etc., are acted upon to some extent, the stimulating influence 
is most conspicuously shown in the production of convulsions, 
which are chiefly clonic in character. In the frog it acts, like 
veratrine, directly on the fibres of skeletal muscle, thus produc- 
ing an alteration in the contraction of the muscles; but, unlike 
veratrine, it has no action on the heart. Under its influence 
contractions of a peristaltic nature have been observed in the 
stomach and intestine and also in the uterus, whether pregnant 
or not. The action of sphacelic acid consists in a constriction 
of unstriped muscle, especially of the blood-vessels, and a pri- 
mary depression, resulting in paralysis of the central nervous 
system. The latter is usually the cause of death when it is 
given in fatal amount. The muscular constriction is apparently 
dependent on both a central and peripheral influence, and is 
shown most conspicuously in a tonic spasm of the arterioles, 
leading to a rise of blood-pressure. In man, the pig, and the 
chicken, but not in other animals, the contraction produced in 



920 PHARMACOLOGY AND THERAPEUTICS. 

some of the arterioles is so extreme and prolonged that a hya- 
line formation in the lumen and walls of the vessels takes place 
which effectually obstructs the circulation after the muscular 
coats have relaxed, and gangrene results. This is a typical 
action of sphacelic acid, and it is not met with to nearly the 
same extent in the case of any other known agent. It is ob- 
served in the greatest perfection in the comb of the cock, in 
consequence of the special arrangement of the blood-vessels in 
this structure. In all animals the acid causes contraction of 
the pregnant uterus, peristaltic under moderate doses and often 
tetanic when the quantity is large. From this sketch of the 
chief effects of these two substances the action of ergot itself 
may, it is hoped, be more clearly understood. 

External. — Upon the skin ergot has no appreciable action, 
but upon mucous membranes it has somewhat of an astringent 
and haemostatic effect. 

Internal. G astro -intestinal Tract. — Digestion is much im- 
paired in consequence of the disturbance caused in the circula- 
tion, and vomiting is common, partly in consequence of the 
disturbed circulation and partly from the action of the cornu- 
tine on the medullary centre. Increased peristalsis of the in- 
testine is induced by the stimulation of its muscular walls, and 
diarrhcea frequently results in chronic poisoning. The intes- 
tinal vessels are constricted, partly in consequence of the con- 
traction of their own muscular coats and in part from that of 
the muscular fibres of the bowel. 

Circulation- — A high blood-pressure is indicated by a hard 
and small pulse, which is usually slow also. The rise in blood- 
pressure may for a time be concealed by the slowness of the 
heart, but it is always very marked, and is one of the charac- 
teristic effects of ergot. It is dependent upon a general con- 
traction of the arteries, which appears to be due in part to 
action on the vaso-motor centres and in part to direct action 
on the muscular coats of the vessels. Because it constricts the 
arterioles ergot is haemostatic. Very large doses may paralyze 
the vaso-motor centres, with the effect of causing a fall of 



ERGOT. 92 1 

blood-pressure from vascular dilatation and cardiac depression. 
If ergot is taken continuously for a considerable time gangrene 
in various situations is apt to result from the vascular contrac- 
tion and stasis of the blood stream, with coagulation and hya- 
line thrombosis. This is a prominent feature of chronic poison- 
ing, which is known as ergotism, and it was frequently met 
with in former times among the lower classes of Europe, who 
after poor harvests especially were obliged to use bread con- 
taining ergot. 

Nervous System. — Besides the gangrenous form of chronic 
ergot poisoning, the other principal form is the convulsive. 
The differences in the several varieties of ergotism are ex- 
plained by the different actions of the constituents of the drug 
and by the fact that they may act partly on the blood-vessels 
and in part directly on the central nervous system. In some 
epidemics both the gangrenous and convulsive forms have been 
present, but, as a rule, one has been much more prevalent than 
the other. In convulsive or spasmodic ergotism there are at 
first formication, itching and tingling of the surface, followed 
by numbness and local anaesthesia. Not infrequently anaesthe- 
sia and hyperesthesia are found at the same time in different 
parts, or even in the same part. These manifestations com- 
mence in the hands and feet, and then spread over the whole 
body. This disturbance of sensation even affects the alimen- 
tary canal, so that there may be present at once both voracious 
hunger and loss of appetite. At the same time there are much 
weakness and depression, often with severe headache and gid- 
diness, as well as central disturbances of the special senses, 
such as dimness of vision and impairment of the hearing. 
There may follow convulsions, usually clonic in character and 
often epileptiform, and these have as sequelae contractures in 
the limbs and sometimes in the trunk muscles. The disease 
was immediately fatal in a large proportion of cases in earlier 
times, and when recovery took place it was apt to be followed 
by more or less loss of intellectual power, and in some instances 
by complete dementia. 



922 PHARMACOLOGY AND THERAPEUTICS. 

Uterus. — One of the most prominent features of the action 
of ergot is its property of exciting contractions in the pregnant 
uterus. Whether the ecbolic effects of ergot are due to its 
action on the uterus itself or on the nervous centres is still 
an unsettled question. Its action upon the unimpregnated 
uterus appears to be the same in kind, but less marked in de- 
gree, and of much less constant occurrence. 

The saliva, perspiration, urine and milk are diminished by- 
ergot, and this is supposed to be due to the general vascular 
contraction caused by it. 

Therapeutics of Ergot. 
Ergot is chiefly used for the purpose of insuring tonic con- 
traction of the uterus after parturition, and thus guard against 
the occurrence of post-partum haemorrhage. In case severe 
haemorrhage is threatened, it is advisable, in order to obtain a 
more prompt effect, to administer it hypodermatically. The 
modern practice is to forbid the use of ergot until after the 
expulsion of the placenta. The only possible exception to this 
restriction is during the second stage of labor in cases where 
it may seem to be indicated as a prophylactic against post- 
partum haemorrhage. Even under these circumstances it should 
never be given if there be the slightest mechanical obstacle to 
delivery, or if the fcetal head be high up in the pelvic canal. 
That ergot is justifiable in only very exceptional instances is 
illustrated by the fact that out of twenty-seven cases recorded 
by one obstetrical authority in which it was employed during 
the second stage on account of inertia uteri, spontaneous de- 
livery occurred in only seven. If the remedy is made use of 
at this period of labor, it is essential that the foetal heart should 
be carefully watched, so that in case of threatened asphyxia 
instrumental delivery may be promptly resorted to. One great 
objection to the use of ergot before delivery is that the uterine 
contractions induced by it are likely to become more and more 
severe and prolonged, so that ultimately the continued pressure 
may endanger the life of the child, while if serious mechanical 



ERGOT. 923 

obstruction is present, even rupture of the uterus may be 
caused. If employed before the membranes have ruptured, it 
may prevent the further dilatation of the os uteri and deprive 
the foetus of its blood supply through the constriction of the 
uterine vessels. When given, as has been a very common prac- 
tice, at the time of the passage of the child's head, it is likely 
to produce its effect prematurely, and thus to give rise to hour- 
glass contraction and interfere with the expulsion of the 
placenta. 

Ergot enjoys some reputation as an internal haemostatic, and 
in addition to uterine haemorrhage, it has been employed in 
epistaxis, haemoptysis, haematemesis and renal and intestinal 
haemorrhage. While some authorities regard it with much 
favor, it is certainly by no means uniformly successful, and the 
marked increase of blood-pressure which it causes may prove 
a serious objection to its use. In all cases where it is given 
it is of great importance that the preparation should be a reli- 
able one, and that a sufficient quantity should be exhibited. 
Thus, if the fluidextract is selected, it is advised that in urgent 
cases 4 to 8 c.c. (1 to 2 fl. dr.) should be given every half-hour 
or hour. Ergot is often combined with ipecacuanha or astrin- 
gents in these cases. The special indication for its use in 
haemorrhage is regarded as a want of tonicity of the vessels. 
W T here an especially prompt effect is required it should be 
administered subcutaneously, and this method is often prefer- 
able in haematemesis on account of the irritability of the stom- 
ach. With suitable means for improving the quality of the 
blood, it is regarded by some as very serviceable in the haemor- 
rhagic diathesis, but it is not to be relied upon alone. In aneur- 
isms, and especially those beyond the reach of surgical treat- 
ment, ergot may prove distinctly valuable. By its action in 
slowing the heart and causing such contraction of the arterioles 
as to induce a marked increase of blood-pressure, the coagula- 
tion of the blood in the aneurismal sac is promoted. In small 
aneurisms of the peripheral main arterial trunks it is thought 
possible that it may effect a cure by means of the contraction 



924 PHARMACOLOGY AND THERAPEUTICS. 

resulting from its direct action on the unstriped muscular fibres 
in the affected portion of the vessel. It is also recommended 
in miliary aneurisms of the intra-cranial arterioles, giving rise 
to such symptoms as vertigo, epistaxis, headache and tinnitus 
aurium; likewise when there is a sluggish and partially ob- 
structed state of the intra-cranial veins, usually due to chronic 
arteritis and accompanied by hebetude, dizziness, epistaxis, etc. 
In certain forms of mental disease, such as recurrent mania, 
chronic mania with lucid intervals, and epileptic mania, when 
associated with cerebral hyperemia, ergot has been found use- 
ful, and in epidemic cerebro-spinal meningitis it is claimed as 
one of the remedies from which the best results are to be ex- 
pected. Much success is also claimed for it, when given in 
large doses, in congestion of the spinal cord and meninges 
and in acute myelitis, as well as in the congestive form of 
migraine. Other conditions in which it has proved of service 
are acute conjunctivitis and blepharitis, congestive dysmenor- 
rhea, amenorrhea dependent on plethora, incontinence of urine 
caused by a paretic or paralytic state of the bladder sphincter, 
and some forms of spermatorrhoea. It has also been used to 
check the night-sweats of phthisis and as an antigalactagogue. 
It is sometimes beneficial in uterine fibroids and polypi, and 
good results have been obtained from the long-continued use 
of ergotin in chronic metritis. Ergotin, especially when com- 
bined with opium and nux vomica, has been found highly use- 
ful in persistent chronic diarrhoea. 

Ergot is employed to some extent in topical applications. 
Oil of ergot (not official) is serviceable in seborrhcea, loss of 
hair, and sycosis. Ergotin, in combination with various other 
remedies, has been used in ointments for fissures of the nose, 
mouth and anus, haemorrhoids, acne rosacea, boils, etc. 

Not infrequently it is desirable to use the fluidextract of 
ergot in combination with ferric chloride. The inky mixture 
which results, by reason of the tannic acid contained in the 
ergot, may be clarified by the addition of a little citric acid, 
and chloroform water is a good flavoring agent for it. 



HYDRASTIS. 925 

COTTON ROOT BARK. 

GOSSYPII CORTEX (Gossypii Radicis Cortex, U. S. P., 1890).— 
Cotton Root Bark. Dose, 2 m.; 30 gr. 

Unofficial Preparation. 
Extractum Gossypii Radicis Fluidum (U. S. P., 1890). — 
Fluidextract of Cotton Root Bark. — Dose, 1 to 4 C.C.; 14 to 1 
fl. dr. 

Action of Cotton Root Bark. 
Cotton Root Bark has the same action as ergot, and is an 
emmenagogue and an abortifacient. 

Therapeutics of Cotton Root Bark. 

It is used as a uterine haemostatic in the treatment of menor- 
rhagia and metrorrhagia from various causes, and particularly 
from uterine fibroids. 

HYDRASTIS. 
HYDRASTIS.— Hydrastis. (Gold Seal.) Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Hydrastis.— *Fluidextract of Hydrastis. 
Dose, 2 c.c; 30 VS\.. 

2. Tinctura Hydrastis. — Tincture of Hydrastis. Dose, 4 
c.c; 1 fi. dr. 

3. Glyceritum Hydrastis. — Glycerite of Hydrastis. Dose, 
2 c.c; 30 TTL- 

HYDRASTINA.— Hydrastine. Dose, 0.010 gm. (10 milligm.) ; 

1ST' 

HYDRASTININ^E HYDROCHLORIDUM.— Hydrastinine Hydro- 
chloride. Dose, 0.030 gm. (30 milligm.); y 2 S r - 

Action of Hydrastis. 
Hydrastis is a stomachic tonic, and the large amount of 
berberine in its composition would seem to give it a place among 



926 PHARMACOLOGY AND THERAPEUTICS. 

the simple bitters. In moderate doses it promotes appetite and 
digestion, increasing the gastro-intestinal secretions and the flow 
of bile. Its general action is due principally to the alkaloid hy- 
drastine. This primarily stimulates the centres of the medulla 
oblongata, causing slowing of the heart, increased arterial ten- 
sion, and a quickening of the respiration. The rise in blood- 
pressure is due to constriction of the arterioles. Under larger 
amounts there is a stimulation of the spinal cord similar to that 
caused by strychnine and causing clonic convulsions, followed 
by tonic convulsions and tetanus. Furthermore, it weakens and 
paralyzes muscle, an action which is confined to the heart in 
warm-blooded animals, but affects the muscles generally in the 
frog. In consequence of the cardiac depression the blood- 
pressure falls, and eventually both the medulla and cord are 
paralyzed, death occurring from failure of the respiration. 
The constriction of the arterioles is not due, apparently, to any 
direct action on the walls of the vessels, but rather to the 
stimulation of the vaso-motor centre. There seems to be no 
very satisfactory ground for the assertion, made by some writ- 
ers, that hydrastis produces contraction of the uterus, from 
action on the muscle. The drug has decided antiperiodic prop- 
erties. The behaviour of hydrastine towards oxidizing sub- 
stances has led to the supposition that this alkaloid is changed 
into hydrastinine in the body, but this is disproved by the fact 
that it is excreted unchanged in the urine. Hydrastinine has 
been found to cause a much greater constriction of the periph- 
eral vessels, as well as less depression of the heart, than hydras- 
tine. It is also stated to differ from the latter in producing no 
marked disturbance of the centres of motion except when given 
in enormous doses, which paralyze the nervous system. 

Therapeutics of Hydrastis. 
External. — Hydrastis is much used empirically for subacute 
and chronic inflammations of the mucous membranes. It may 
be that the benefit derived from it is due in great measure to 



HYDRASTIS. 927 

its action in causing the contraction of dilated blood-vessels. 
The various preparations, diluted with water, may be employed 
as injections in gonorrhoea, vaginitis, leucorrhoea, otorrhcea, 
and nasal catarrh, and as lotions for syphilitic mouth-lesions, 
mercurial or aphthous stomatitis, follicular pharyngitis, fissured 
nipples, hyperidrosis, acne, seborrhcea, and various other con- 
ditions. A mixture of equal parts of the fluidextracts of hy- 
drastis and ergot has been used as a local application in fissure 
or prolapse of the anus, ulcerations of the rectum,, haemorrhoids, 
and ulcerations or erosions of the os uteri. In the form of 
ointments hydrastine and hydrastinine hydrochloride may be 
used for unhealthy ulcers, sloughing sores, chancroids, etc. 

Internal. — Hydrastis is very useful in gastric catarrh, espe- 
cially when induced by chronic alcoholism, and, combined with 
other appropriate remedies, often proves of service in intes- 
tinal indigestion and various forms of dyspepsia. In chronic 
catarrh of the intestine, even when ulceration has occurred, it 
may prove of great service, and it is especially esteemed in 
duodenal catarrh accompanied by catarrh of the gall-ducts and 
jaundice. It is employed to a considerable extent in uterine 
disorders such as menorrhagia and dysmenorrhcea, and also to 
check the growth of uterine tumors. For the arrest of haemor- 
rhage hydrastinine hydrochloride is to be preferred, but while 
this is valuable in other uterine haemorrhages, it has little or 
no effect in post-partum haemorrhage, so that it would seem 
highly probable that hydrastis has no action on the uterine 
muscle. On account of its marked action in constricting the 
arterioles in general, hydrastinine should prove of service in 
haemorrhages other than uterine. As an antiperiodic, hydras- 
tis, while much inferior, ranks next in value to quinine. In 
chronic malarial cachexia it may be given with iron prepara- 
tions. Hydrastinine has been suggested in epilepsy on the 
ground that it has some effect in diminishing the irritability of 
the motor areas of the brain. 



928 PHARMACOLOGY AND THERAPEUTICS. 

CAULOPHYLLUM. 

Unofficial Preparation. 

Caulophyllum (U. S. P., 1890).— Caulophyllum. (Blue 
Cohosh. Squaw Root.) Dose, 0.30 to 2 gm.; 5 to 30 gr. 

Action of Caulophyllum. 
But little is known positively of the effects of this drug, but 
it is regarded as sedative, antispasmodic and oxytocic. 

Therapeutics of Caulophyllum. 
Caulophyllum is used to increase the force of uterine con- 
tractions ; it has been employed as a remedy for deficient labor- 
pains, and is believed to be useful in dysmenorrhea. 

SAVIN. 
SABINA.— Savin. Dose, 0.5 gm.; 7V 2 gr. 

Preparation. 
Fluidextractum Sabinse. — Fluidextract of Savin. Dose, 0.3 



c.c; 5 tt\. 



OLEUM SABIN^E.— Oil of Savin. Dose, 0.05 c.c; 1 m,. 

Action of Savin. 
Oil of savin has the same action as oil of turpentine, but it 
is more marked. Thus externally it causes great redness, pain, 
vesication, and even pustulation. Internally it may produce 
severe gastro-intestinal irritation, with vomiting, abdominal 
pain and purging. In its excretion through the kidney and the 
mucous membranes of the genito-urinary tract it severely irri- 
tates them; thus hematuria, scanty urine, and pain on micturi- 
tion may follow its use. The point in which the action of oil 
of savin differs from that of the oil of turpentine is that it 
powerfully irritates the ovaries and uterus, causing hyperemia 
of these organs and accelerating menstruation. It also induces 
contractions of the pregnant uterus, and therefore it is an 
ecbolic. 



CIMICIFUGA. 929 

Therapeutics of Savin. 
A cerate made from the fluidextract, I, in rosin cerate, 4, 
has been used as a powerful irritant and counter-irritant, and 
internally savin may be given as an emmenagogue; but, on the 
whole, its use is to be discouraged, as it is so liable to cause 
serious gastro-enteritis. It has often been administered as an 
ecbolic with criminal intent, but it is rarely used in medicine. 

RUE. 

Unofficial Preparation. 
Oleum Eutae.— Oil of Rue. Dose, .06 to .25 c.c; 1 to 4 HI. 

Action of Oil of Rue. 

External. — Oil of rue is irritant and vesicant. 

Internal. — In large doses it is a powerful gastro-intestinal 
irritant. It is eliminated in, and may be recognized by its odor 
in the urine, breath and perspiration. It is irritant to the kid- 
neys, ovaries and uterus, and excites the menstrual flow. In all 
points its action resembles that of savin. 

Therapeutics of Oil of Rue. 
From its stimulating action on the uterus rue has been used 
for amenorrhcea and also as an abortifacient, and fatal cases 
of poisoning by it, from gastro-intestinal irritation, have been 
recorded. It is very rarely given as a medicine. 

CIMICIFUGA. 

CIMICIFUGA.— Cimicifuga. (Black Snakeroot. Black Cohosh.) 
Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Cimicifuga. — Fluidextract of Cimicifuga. 
Dose, 1 c.c; 15 Hi. 

2. Extractum Cimicifuga. — Extract of Cimicifuga. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

3. Tinctura Cimicifuga. — Tincture of Cimicifuga. Dose, 4 
c.c; 1 fl. dr. 

60 



930 PHARMACOLOGY AND THERAPEUTICS. 

Action of Cimicifuga. 
Cimicifuga is an astringent bitter and to some extent a car- 
diac stimulant, slowing the action of the heart, but increasing 
its force. Its action in this respect is not important. In large 
doses it depresses the heart and vaso-motor system. In frogs 
it paralyzes the sensory side of the spinal cord, producing com- 
plete anaesthesia, with loss of reflex activity, at a time when 
voluntary movement is still preserved. The respiration is de- 
pressed and finally arrested. Cimicifuga is said to cause uter- 
ine contractions. 

Therapeutics of Cimicifuga. 
It has been employed in a great variety of conditions. 
Among them may be mentioned dyspepsia, fatty and irritable 
heart, dysmenorrhcea, amenorrhcea, subinvolution, rheumatism, 
neuralgia, chronic bronchitis, and especially chorea. That it 
is of very much benefit beyond that accomplished by a simple 
bitter is open to question. It has been asserted that it some- 
times promptly cures urticaria of nervous origin after the 
failure of other treatment. 

D. Emmenagogues. 
MANGANESE. 

MANGANI DIOXIDUM PR^CIPITATUM.— Precipitated Man- 
ganese Dioxide. (Black Manganese Oxide.) Dose, 0.250 gm. (250 
milligm.) ; 4 gr. 

MANGANI SULPHAS.— Manganese Sulphate. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

Action of Manganese Dioxide. 
When given by the mouth the salts of manganese exercise 
an effect only in so far as they are dissolved in the secretions. 
In large amounts they cause gastro-intestinal irritation, and in 
smaller doses have some astringent action. When given by 
subcutaneous or subvenous injection they cause descending 



APIGL. 93 I 

paralysis of the brain and spinal cord in frogs, and may give 
rise to epileptiform convulsions in mammals. These salts, and 
especially the dioxide, are thought by many to have a specific 
influence upon the uterus. 

Therapeutics of Manganese Dioxide. 

It has been used empirically as an emmenagogue and is prob- 
ably the most certain of all when administered in maximum 
dose. 

Action of Manganese Sulphate. 

Like the dioxide, manganese sulphate in small doses has a 
somewhat astringent effect, but larger amounts (2 to 4 gm. ; 
30 to 60 gr.) cause vomiting and purging, in consequence of 
the local irritation of the stomach and intestine. As in the case 
of iron, only a very minute quantity is absorbed from the ali- 
mentary canal, and no constitutional symptoms 'have been ob- 
served from its prolonged administration by the mouth to 
animals. 

Therapeutics of Manganese Sulphate. 
It has been used as a cholagogue purgative, but on account 
of its irritating properties it is a very unsafe remedy. Its 
action upon the uterus is much less pronounced than that of 
the dioxide. 

APIOL. 

Unofficial Preparation. 

Apiolum. — Apiol. (Parsley.) Dose, 0.60 to 1 C.C.; 10 to 
15 TTl. 

Action of Apiol. 
Apiol in large doses acts as a cerebral and circulatory stim- 
ulant. It is also believed to have a special action on the uterine 
circulation. 

Therapeutics of Apiol. 
It is useful in amenorrhcea, scanty menstruation, and dys- 
menorrhcea when administered immediately before the expected 



932 PHARMACOLOGY AND THERAPEUTICS. 

period in cases in which these conditions are due to a want of 
ovarian activity; that is, where direct emmenagogues are 
required. 

TANSY. 

Unofficial Preparation. 
Tanacetum (U. S. P., 1890). — Dose, 1 to 4 gm.; 14 to 1 dr. 

Action of Tansy. 
Tansy possesses the properties of an aromatic bitter, and is 
an irritant narcotic. 

Therapeutics of Tansy. 
It has been used as an abortifacient, but is dangerous in 
large doses, several fatal cases having been recorded. 

E. Substances which Depress Uterine Action. 
VIBURNUM. 

VIBURNUM PRUNIFOLIUM.— Viburnum Prunifolium. (Black 
Haw.) Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Viburni Prunifolii. — Fluidextract of Vibur- 
num Prunifolium. Dose, 2 C.C.; 30 til. 

VIBURNUM OPULUS. — Viburnum Opulus. (Cramp Bark.) 
Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Viburni Opuli. — Fluidextract of Viburnum 
Opulus. Dose, 2 c.c.; 30 n\. 

Action of Viburnum. 
Viburnum is believed to be an antispasmodic, diuretic and 
tonic. 

Therapeutics of Viburnum. 
It is especially used in the nervous diseases of pregnancy and 
to prevent miscarriage. It has considerable reputation as a 



ANTITOXINS AND SERUMS. 933 

remedy for spasmodic dysmenorrhcea, in the treatment of after- 
pains, and in menorrhagia. This remedy has been in extensive 
use for more than twenty-five years and is undoubtedly of 
value. 

Division XII. — Antitoxins and Serums. 
Antitoxins and serums have been classed by some among 
alterative remedies, and there is a certain amount of reasonable- 
ness in this designation; but their manner of action and the 
methods by which they are administered are so different from 
those of ordinary alteratives that it seems preferable to give 
them in a division by themselves. To the class of substances 
(believed to be of albuminous nature) produced in the animal 
organism by pathogenic germs which is deleterious to the ani- 
mals themselves the name toxin has been given, while to a 
different class of substances, also albuminous and also produced 
by the same germs, but which is inimical to the bacteria, the 
name antitoxin has been assigned. The toxin acts both as a 
local and systemic poison, and by its hostile influence upon the 
bacteria the antitoxin tends to counteract both of these effects. 
The precise modus operandi is as yet unknown, but it is thought 
probable that the antitoxin affects the protoplasm in such a way 
as to render it capable of resisting the action of the toxin. It 
is to be noted, however, that the antitoxin has been demon- 
strated not to be a germicide, and thus capable of killing the 
pathogenic organism; so that there is still considerable mystery 
as to just how it produces the beneficial effects observed from 
it. The antitoxins are: 

(1) Diphtheria Antitoxin. (2) Tetanus Antitoxin. 

The most important one is diphtheria antitoxin. 

Serums, other than antitoxins or nutrient serums, are attenuated 
cultures made from pathogenic germs, and often called vaccines, the 
administration of which is designed to confer immunity from the spe- 
cial disease represented by the germs from which the cultures are 
made. Among the serums which have been employed are the follow- 
ing : 



934 



PHARMACOLOGY AND THERAPEUTICS. 



(1) Antistreptococcic Serum. 

(2) Antipneumococcic Serum. 

(3) Antivenomous Serum. 



(4) Antiplague Serum. 

(5) Anticholera Serum. 

(6) Antityphoid Serum. 



For the sake of convenience Nutrient Serum, which is supposed to 
replace the blood serum, and also Hydrophobia Antidote, although it 
is neither an antitoxin nor a serum, are considered in this Division. 

SERUM ANTIDIPHTHERICUM.— Antidiphtheritic Serum. Diph- 
theria Antitoxin. Dose, 3000 units. Immunizing dose for well per- 
sons, 500 units. 



Action of Diphtheria Antitoxin. 

Antitoxin serum has a favorable effect upon all the symp- 
toms of diphtheria and also a marked influence in preventing 
the occurrence of sudden heart-failure which constitutes one of 
the great dangers of the disease. The temperature, however, 
is less affected than the other symptoms. Statistics collected 
from reliable sources afford overwhelming evidence as to the 
value of antitoxin in reducing the mortality from diphtheria. 
They also show that the frequency of laryngeal diphtheria is 
diminished by its use, and that the mortality of patients upon 
whom intubation or tracheotomy has been practiced is likewise 
diminished. Furthermore, the time during which the tube must 
be worn is decreased. After the serum has been employed, it 
is found that although the bacilli continue to be present, the 
formation of membranous exudation ceases, and that which is 
already present rapidly disappears. Consequently, if antitoxin 
be used early, the membrane rarely extends from the fauces 
into the larynx. It is not until twenty-four hours after injec- 
tion, however, that the maximum effect of the antitoxin is ob- 
served. It is stated that the frequency of the occurrence of 
post-diphtheritic paralysis is not diminished, although the per- 
centage of recoveries in cases with paralysis is slightly in- 
creased. 

The use of the antitoxin is sometimes attended with untoward 
effects, but as a rule these are of very little importance. That 
they are not due to the antitoxin itself, but to something else 



ANTIDIPHTHERITIC SERUM. 935 

in the serum, seems to be shown by the fact that they may 
result from the injection of the simple serum of animals. The 
most common of these is a rash, usually erythematous in charac- 
ter, but sometimes resembling measles or urticaria, and another 
is pain and swelling in the joints. Somewhat rarely there have 
been observed an irregular temperature range and consecutively 
emaciation and death; evidently pointing toward an acquired 
septicaemia. Further, in a few cases an early fatal result has 
been reported. It has been shown that in a fatal issue nephritis 
is the cause of death in a majority of instances, and clinically 
hemorrhagic nephritis is by no means rare. 

Therapeutics of Diphtheria Antitoxin. 
As the mortality of the disease when antitoxin is used in- 
creases in proportion to the lateness of its employment, it is 
evident that the administration should be commenced at the 
earliest possible moment. It is the safest plan to give antitoxin 
on a clinical diagnosis, without waiting for a bacteriological 
culture. Inasmuch as this remedy militates solely against the 
infection of the Klebs-Loeffler bacillus and clinically most cases 
of diphtheria are cases of mixed infection, the usual local anti- 
septic and general supporting measures must not be omitted. 
The danger of antitoxin lies in the horse-serum, for, many years 
before antitoxin was made, the results of injection of an alien 
serum had been pointed out. Concentrated serums then should 
be preferred in that they give the largest amount of antitoxin 
with the smallest amount of serum. In cases of moderate 
severity it is recommended that a dose of 5000 units (10 c.c. 
of serum containing 500 units per c.c.) should be given at once. 
A second injection may not be required, but if the symptoms 
demand it, the dose should be repeated two or three times at 
intervals of twelve hours. In severe cases, or in those treated 
late, the dose should be 8,000 to 10,000 units. If no ameliora- 
tion of the condition is observed within two or three days, the 
further continuance of the treatment appears to be useless. 
The injections are usually made, with a specially devised 






936 PHARMACOLOGY AND THERAPEUTICS. 

syringe, between the shoulders or on the side of the abdomen, 
and should be given under strict aseptic precautions. 

So far as prophylaxis is concerned, the question is still sub 
judice. Many failures are reported, and, indeed, instances of 
reinfection have occurred even after suitable doses of antitoxin 
have been used during a previous attack. 

Unofficial Preparation. 
Serum Antitetanicum. — Antitetanus Serum. Tetanus Anti- 
toxin. Dose, 10 to 20 c.c; 2y 2 to 5 fl. dr. 

Action of Tetanus Antitoxin. 
While diphtheria is recognized by the local inflammation long 
before the nerves and heart have become affected, tetanus is 
first recognized only when the poison has gained access to the 
central nervous system. The hypothesis has been advanced 
that the toxin of the bacillus tetanus has a chemical affinity for 
nerve-tissue, and enters into chemical combination with and 
destroys such tissue, and that the convulsions result from the 
changes thus brought about in the nerve centres. Furthermore, 
that the antitoxin, having no such chemical affinity, is capable 
of neutralizing only the toxin that may still remain in the cir- 
culation, and naturally cannot have any effect on the destruc- 
tive lesions already present in the centres. While tetanus 
serum possesses antitoxic, it has no antibacterial properties. 

Therapeutics of Tetanus Antitoxin. 
In view of the extreme gravity of the disease, in acute and 
rapidly developing cases it would seem advisable to employ the 
serum freely at the earliest possible moment in every case of 
tetanus. The injections may be repeated every six or twelve 
hours at first, and afterwards at longer intervals if there is 
evidence of improvement. In some instances the antitoxin has 
been injected directly into the brain, after trephining the skull, 
and in others into the spinal cord, and this is preferable in 
severe cases. In any case of injury in which there appears to 



ANTIDIPHTHERITIC SERUM. 937 

be a likelihood of the development of tetanus the use of the 
serum as a prophylactic is advisable. 

It is a well-known fact that tetanus toxin has proved far less 
successful than diphtheria antitoxin, and quite recent investiga- 
tions have presented an explanation of the difficulties met with 
in the use of this serum. In these it was found that not only 
is the tetanus toxin carried to the central nervous system along 
the motor nerves, but also that the toxin gains entrance to the 
nerves through the motor end-plates, that it does not reach the 
central nervous system by any other route than the nerves, that 
tetanic rigidity is altogether a result of central irritation, and 
that the latent period between the injection of toxin (in ex- 
periments on animals) and the onset of tetanic symptoms is 
almost altogether due to the time required for the toxin to 
pass along the motor nerves to the cord or brain. Further- 
more, it was found that tetanus antitoxin is not carried along 
the nerves, and has practically no action except upon that toxin 
which has not yet entered into the motor axis cylinders. Other 
recent experiments also go to show that the toxin is absorbed 
only by the motor nerves; the antitoxin only by the circulation 
and lymph. This peculiar mechanism, now demonstrated for 
the first time, brings the tetanus toxin in concentrated form 
upon the susceptible cells along the motor axis cylinders, and it 
furthermore places the toxin at an early period (and some time 
before the onset of symptoms) beyond the reach of the anti- 
toxin. From these researches the following practical lessons 
have been drawn : ( I ) Subcutaneous, intravenous and subdural 
injections of antitoxin are of no value as measures to relieve 
tetanus when the symptoms have once appeared. (2) Injec- 
tions of antitoxin, especially near the injected wound, will effec- 
tually bind any toxin present in the system: i. e., toxin before 
it has been picked up by the motor end-plates. (3) It is prob- 
able that injections of antitoxin directly into the motor nerve 
leading from the infected wound, or even into the segment of 
the cord reached by this nerve, will have some influence upon 
the toxin. 



93 8 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Serum Antistreptococcicum. — Antistreptococcic Serum. 
Dose, 10 to 20 c.c; 2y 2 to 5 fl. dr. 

Action of Antistreptococcic Serum. 

Antistreptococcic serum has been used to a limited extent 
for some time, but it labors under the great disadvantage that 
different cultivations of apparently the same streptococcus show 
such variance that serum which is bactericidal to one cultiva- 
tion may not be so to another. 

Therapeutics of Antistreptococcic Serum. 

It has been employed in various diseases in which infection 
is largely attributed to the streptococcus, such as erysipelas, 
malignant endocarditis, otitis media, thrombosis of the lateral 
sinus, and puerperal and surgical septicaemia; and trial may be 
made of it in any affection attended with the presence of strep- 
tococci. While the results are not infrequently disappointing, 
successful cases have been recorded in the disorders mentioned, 
and also cases of scarlet fever in which it has apparently proved 
useful in shortening the course of the disease and in prevent- 
ing serious complications and sequelae, such as otitis media and 
other suppurative processes, due to this microbe. It has per- 
haps been found of most service in erysipelas and puerperal 
septicaemia, and it is recently reported to have been used suc- 
cessfully in grave cases of scarlet fever and in inflammatory 
rheumatism. With an increased knowledge of its appropriate 
application there seems every reason to believe that the serum 
will prove a valuable addition to our therapeutic resources. 
The chief beneficial effects observed from its use are a fall in 
temperature and a general improvement in the patient's con- 
dition. In many acute cases such effects have been noted after 
each injection. In acute cases the serum may be administered 
two or three times a day, and in chronic cases once daily. 



ANTIDIPHTHERITIC SERUM. 939 

Unofficial Preparation. 
Serum Antipneumococcicum. — Antipneumococcic Serum. 
Dose, 10 to 20 c.c; 2y 2 to 5 fl - dr« 

Action of Anti-Pneumococcic Serum. 
This serum is antibacterial, but does not appear to possess 
antitoxic properties. As in the case of antistreptococcic serum, 
there are serious difficulties in its practical application. Pneu- 
mococci, when derived from various sources, differ from one 
another in virulence and in cultural characteristics; hence a 
serum which proves protective in some instances may be of no 
value in others. Consequently, the results thus far obtained 
have not been very satisfactory. 

Therapeutics of Anti-Pneumococcic Serum. 
The serum is injected subcutaneously, and it is advised that 
the doses should be given twice a day until the temperature has 
subsided and the patient is convalescent. It is thought possible 
that it may be of more advantage in some other pneumococcal 
affections (such, for example, as infective endocarditis) than 
in pneumonia itself. 

Unofficial Preparation. 
Serum Antivenenosum. — Antivenomous Serum. (Anti- 
venene.) Dose, 10 to 30 c.c; 2y 2 to 8 fl. dr. 

Action of Antivenomous Serum. 
This serum is protective in animals when employed before, 
at the same time, or shortly after inoculation with snake poison. 
The immunity conferred by it, however, is found not to last 
longer than six days. Up to a certain period after inoculation 
the serum is protective, even though symptoms of poisoning 
may have manifested themselves; but after that no amount of 
it, however large, can prevent a fatal result. 



940 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Antivenomous Serum. 
The serum should be administered as soon as possible after 
the snake bite. It may be given subcutaneously, but, on account 
of the greater rapidity of absorption, it is preferable to inject 
it into a vein, due aseptic precautions being taken. The results 
of this treatment thus far recorded leave no doubt of its ex- 
treme value. In a number of instances recovery from the bites 
of venomous snakes has taken place even after well-marked 
symptoms of poisoning had made their appearance. 

Unofficial Preparation. 
Serum Antipestilens. — Anti-plague Serum. Dose, 10 to 20 
c.c; 2y 2 to 5 fl. dr. 

Action of Anti-Plague Serum. 
Anti-plague serum is antibacterial. If, as is said to be the 
case, it also possesses antitoxic properties, these seem to vary 
with the method of preparation, and are certainly less pro- 
nounced than the antibacterial. The prophylactic vaccine (in- 
oculation) contains the toxins derived from the bodies of the 
bacteria and also those produced in or diffused into the sur- 
rounding medium, which are stated to be so modified as to be 
almost entirely nonpathogenic to susceptible animals. From 
three to five hours after inoculation there is a marked rise of 
temperature, with pain and swelling at the site of inoculation. 
While the temperature subsides in from twenty-four to thirty- 
six hours, the latter symptoms continue for several days. 

Therapeutics of Anti-Plague Serum. 
The anti-plague serum, which is injected subcutaneously, 
should be administered as early as possible. Two or three doses 
should be given the first day, and one dose daily afterwards. 
The results thus far obtained with this serum have not been 
very encouraging. While in some cases it appears to do good, 
in others it has no effect. Such protection as is afforded by it 



ANTICHOLERA SERUM. 94 1 

has been found to last for only a few days, so that it is avail- 
able as a prophylactic only under special circumstances. 

The prophylactic vaccine should be injected, with strict asep- 
tic precautions, into the subcutaneous tissue, preferably by the 
arm. It is stated that if the temperature does not rise as high as 
38.8 C. (102 F.) in several individuals, the prophylactic is 
not up to the standard potency, and increased doses must be 
given. From an extensive use of this vaccine, particularly in 
India, its efficacy against plague appears to be clearly estab- 
lished, and it is believed that still more favorable results will 
be obtained when better methods of standardizing the prophy- 
lactic have been obtained and further improvements made in 
the method of preparation. 

Unofficial Preparation. 
Serum Anticholeraicum. — Anticholera Serum. Dose, 10 to 
20 c.c; 2y 2 to 5 fl. dr. 

Action of Anti-Cholera Serum. 
This serum is antibacterial, but not antitoxic; it is said to 
protect against the living vibrios but not against their toxins. 
Two prophylactic vaccines have been used, one consisting of 
an emulsion in sterile broth of a fresh agar cultivation of viru- 
lent vibrios, and the other of an emulsion in sterile broth made 
from attenuated vibrios. They must be administered immedi- 
ately after being made. One vaccine (inoculation) is used five 
days, or more, after the other, and they are injected into the 
subcutaneous tissue of the abdomen under strict aseptic pre- 
cautions. There is a moderate, but brief, febrile reaction after 
the first vaccination, and a less marked one after the second. 

Therapeutics of Anti-Cholera Serum. 
As the serum has no antitoxic properties and as the disease 
runs such a rapid course, this serum does not appear to have 
any value in the treatment of cholera. On the other hand, 



942 PHARMACOLOGY AND THERAPEUTICS. 

prophylactic vaccination (inoculation) affords considerable 
protection against the disease. The statistics of its employ- 
ment in India, however, go to show that while it undoubtedly 
diminishes the actual number of deaths from cholera, this is 
due to the smaller number of individuals attacked, in conse- 
quence of its prophylactic agency, and not to a decrease in the 
case mortality. It appears, therefore, that if a vaccinated per- 
son contracts the disease, he has no better chance of recovery 
than an unvaccinated one. The dose is stated to be an eighth 
part of an emulsion made in sterile broth from the whole of 
an agar cultivation which has been incubated for twenty-four 
hours at a temperature of 35 C. (95 F.). 

Recent investigations have shown that in many instances, at 
least, of the severe summer diarrhoea of infants and young 
children the infection is due to the bacillus of dysentery (Shi- 
ga's bacillus), and a serum against this has been prepared. 
Although but a very limited trial of this has as yet been made, 
the results obtained with it are stated to have been such as to 
lead to the hope that much may be expected from this method 
of treatment in the future. It has also been proposed to use 
an attenuated serum for prophylaxis against dysentery in per- 
sons exposed to the disease, as in the case of troops in tropical 
climates. It has been found feasible to protect small animals, 
like guinea pigs, against the bacillus. Such inoculation is at- 
tended with no danger whatever, but whether it is really effec- 
tive as an immunizing agent can only be determined after 
extended trial and observation. 

Unofficial Preparation. 
Serum Antityphoideum. — Antityphoid Serum. 

Action of Anti-Typhoid Serum. 
The inoculation of dead typhoid bacilli, for prophylactic pur- 
poses, is made, with strict aseptic precautions, into the subcu- 
taneous tissue of the abdomen. It is followed in three or four 
hours by local inflammatory reaction and by pyrexia which 



NUTRIENT SERUM. 943 

usually subsides within twelve hours. The average tempera- 
ture observed is about 38.8 C. (102 F.). 

Therapeutics of Anti-Typhoid Serum. 

It is advisable that the injection should be made in the even- 
ing, so that the patient may go to bed as soon as the symptoms 
make their appearance. In order to secure the best chance of 
success the inoculation may be repeated in a week. At present 
no definite conclusions can be reached as to the immunizing 
power of this method, but the inoculation appears to exercise 
a pronounced influence on the system, since it renders the blood 
serum capable of agglutinating typhoid bacilli. The dose of the 
strongest vaccine prepared is about 5 c.c. (8 ni) and of the 
weakest, 1.5 c.c. (25 til). 

As to the treatment of typhoid with anti-typhoid serum, there 
is as yet no reliable evidence that the procedure is of value. 
Cases thus treated have from time to time been reported, but 
the fact that the serum employed, so far as known, was not 
standardized renders it impossible to judge of results. 

Unofficial Preparation. 
Serum Nutriens. — Nutrient Serum. Dose, 30 to 120 c.c; 
1 to 4 fl. oz. 

Action of Nutrient Serum. 
At the time of the first introduction of diphtheria antitoxin 
a very large amount of the serum had to be injected, on account 
of its diluteness; as much as 320 c.c. (10 fl. oz.) being used in 
two days for a child of five years. As the employment of such 
quantities was found to be attended by no bad results, the idea 
was suggested that serum might be injected subcutaneously as 
a food, and a series of experimental researches in animals was 
accordingly instituted for the purpose of determining, as far as 
possible, the practical utility of this procedure. The results of 
these were as follows: The injection of small quantities of 
serum, by increasing the katabolism of the body, induces an 



944 PHARMACOLOGY AND THERAPEUTICS. 

increase of urinary nitrogen, and a loss of weight, but when 
large quantities are employed, the loss from the increased kata- 
bolism caused is more than offset by the utilization of the serum 
as a food. It was thus found that in animals which were de- 
prived of all other means of sustenance life was prolonged for 
a very considerable period by the subcutaneous injection of 
serum in sufficient quantity. Furthermore, it was ascertained 
that if the serum be heated to 65 C. (149 F.), this has the 
effect of destroying the bodies which produce increased nitrog- 
enous katabolism and also those which give rise to certain un- 
toward effects when the serum of one animal is injected into 
another of a different species. At the same time, the nutritive 
value of the serum remains unimpaired. These results have 
therefore been made use of in the human subject. 

Therapeutics of Nutrient Serum. 

A horse-serum or sheep-serum, heated to the proper tempera- 
ture, may be injected in a variety of conditions: as after grave 
abdominal operations when it is impossible or inadvisable to 
feed the patient by the mouth or rectum, in the vomiting some- 
times met with in post-diphtheritic paralysis, or in certain cases 
of gastric ulcer, typhoid fever, infantile diarrhoea, etc. The 
dose for an infant is 30 to 40 c.c. (8 to 10 fl. dr.), for a child, 
60 to 80 c.c. (16 to 20 fl. dr.), and for an adult 100 to 120 c.c. 
(3 to 4 fl. oz.), and these doses may be repeated as required. 
Where the daily administration of the serum is called for, the 
injection should be made each time in a different part of the 
body in order to avoid undue local irritation. Goat serum or 
lymph has been employed to improve the general nutrition in 
many chronic diseases with some benefit. The exaggerated 
claims formerly made for it, however, have not been substan- 
tiated. 

Unofficial Preparation. 
Antidotum Rabiis. — Hydrophobia Antidote. 



ORGANIC EXTRACTS. 945 

Action of Hydrophobia Antidote. 
It has of late years been the practice when a person has been 
bitten by a dog supposed to be rabid to inoculate him on suc- 
cessive days with rabbits' spinal cords of progressively increas- 
ing virulence, and it has been claimed that if this treatment is 
begun soon after the bite, hydrophobia does not usually de- 
velop. The spinal cords employed are taken from rabbits 
which have been inoculated with rabies. For inoculating the 
human subject emulsions of dried cords are employed, and the 
virulence of the injection depends on the shorter or longer time 
for which the cord used has been allowed to dry. 

Therapeutics of Hydrophobia Antidote. 
The reports of the use of this suggest that some of the 
deaths after treatment may be due to it rather than to the bite. 
Inasmuch as the incubation period of hydrophobia is so ex- 
tremely variable, the pathological findings so inconstant and 
the symptoms so diverse, there is much reason for doubting the 
existence of the disease in man. At least, the majority of al- 
leged cases have been shown to have been those of various 
diseases (tetanus, septicaemia, hysteria). For this reason the 
antidote possesses but little interest save to those who are inter- 
ested in spreading hydrophobia-phobia. 

Division XIII. — Organic Extracts. 
The glands of the body, it is thought, are more or less inter- 
changeable in their functions; so that if one is unable to do its 
work, another seems to assume extra activity. It is now a 
recognized fact that the blood is continuously supplied by cer- 
tain glands with substances which are essential to the welfare 
of the system; so that a lack of these induces very serious re- 
sults. It has been demonstrated also that the bad effects fol- 
lowing the excision of the glands can be successfully obviated 
by the administration of the gland substance. The use of ex- 
tracts of the glands of the body, known as animal extracts or 
61 



946 PHARMACOLOGY AND THERAPEUTICS. 

organic extracts, now has a legitimate place in medicine. They 
are usually active when given by the mouth, as well as by sub- 
cutaneous or intravenous injection, and thus present a marked 
contrast to the antitoxins, which, being proteid substances, are 
destroyed in the stomach. The chief object of the therapeutic 
employment of the organic extracts has hitherto been to supply 
a deficiency of the normal secretion, but at present their field 
of usefulness is becoming more and more extended, as their 
pharmacological action becomes more definitely understood and 
their practical therapeutic value is demonstrated in various 
pathological conditions. It seems altogether probable that the 
further developments in the subject of organo-therapy will be 
of great interest and utility. The organic extracts most in use 
are: 



(1) Thyroid Extract. 

(2) Suprarenal Extract. 

(3) Thymus Extract. 

(4) Pituitary Extract. 

(5) Mammary Extract. 



(6) Ovarian Extract. 

(7) Testicular Extract. 

(8) Brain Extract. 

(9) Splenic Extract. 



These substances might, with better reason than the anti-toxins and 
serums, be classified with the alteratives, but inasmuch as each one 
has a definite, aside from a general, action they are properly considered 
separately. The extract which is of the greatest practical importance 
is the thyroid, and next to that comes the suprarenal. 

GLANDULE THYROIDEiE SICCJE.— Desiccated Thyroid Glands. 
(Thyroid Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 
Liquor Glandularum Thyroidearum. — Solution of Thyroid 
Glands. (Solution of Thyroid.) Dose, .30 to 1.00 c.c; 5 to 
15 HI. 

Iodothyrinum. — Iodothyrin. (Thyroiodin.) Dose, .06 to .30 
gm.; 1 to 5 gr. 

Action of Thyroid Gland. 
Circulation. — The thyroid gland is thought to be probably 
the main organ of the body to furnish vaso-dilating material. 



DESICCATED THYROID GLANDS. 947 

and the administration of its substance has the effect of dilat- 
ing the peripheral blood-vessels and reducing arterial tension. 
Consequently, the cutaneous surface becomes flushed and moist, 
and the cardiac action is more or less depressed. Unless its 
use is continued for a considerable time it has only a slight 
action on the heart muscle, but small doses increase and large 
doses diminish its force. The pulse-rate is quite constantly 
accelerated. Injections of thyroid extract into the circulation 
have been found to cause a fall in blood-pressure of relatively 
short duration. The only effect of ordinary doses observed on 
the blood is an augmentation of lymphocytes. 

Alimentary Canal. — Loss of appetite and diarrhoea are quite 
frequently caused by large amounts and occasionally by small 
doses. 

Nervous System. — Thyroid is a cerebral stimulant, capable 
of causing wakefulness, acuteness and rapidity of thought, and 
general brain activity. Given to excess, it produces headache, 
nervousness, restlessness, insomnia, palpitation, hot flushes, 
sweating, increased irritability of the reflexes, tremors of the 
extremities, and even convulsions. 

Kidneys. — The quantity of urine is uniformly increased. 
This effect has been thought by some to be due to some specific 
action on the kidney, or to the changes in the circulation, but 
it may possibly result simply from the augmented excretion of 
urea and other urinary elements. In some instances sugar is 
found in the urine. 

Metabolism. — A greatly increased oxidation is induced, both 
nitrogenous and non-nitrogenous bodies being rapidly used up. 
On this account there is an increased excretion of urea, uric 
acid, and xanthin bases in the urine and of carbon dioxide by 
the lungs. It is found that the first effects are upon fat, the 
proteids not being acted upon until this has been reduced to a 
certain minimum. These tissue changes result in a rise of 
temperature and a loss of body weight. 

Excretion. — The elimination of the active constituents of 
thyroid gland takes place, so far as known, entirely through 
the kidneys. 



948 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Thyroid Gland. 
In man and the monkey one of the constant and characteris- 
tic effects of removal of the thyroid gland is a myxcedematous 
condition. At an early period there is an abundance of mucus 
and later there occurs a marked hyperplasia of connective tis- 
sue, embryonic in character. The skin is hard, rough and dry, 
because there is no secretion, and the hair loses its vitality and 
falls out. Among the other changes observed are, abdominal 
vaso-dilation, fatty and colloidal degeneration of the liver and 
kidneys, and hyaline degeneration of the arterial walls. All 
of these phenomena may be made to disappear by feeding thy- 
roid. It is also a well known fact that atrophy of the thyroid 
gland always accompanies myxcedema, and it has been found 
that if patients suffering from this affection are treated with 
sheep's thyroid, all the symptoms disappear, usually in about 
six weeks. For the treatment of myxcedema the solution is 
preferable to the powder, as the latter is liable to decomposi- 
tion. .30 c.c. (5 TTi) may be given three times a day in water, 
and the dose gradually increased to .60 c.c. (10 1*1). After the 
symptoms have all disappeared it will be necessary, in order 
to prevent a recurrence, that the patient should take the latter 
dose about twice a week for the rest of his life. Compressed 
tablets of the powder are very convenient to take, and are used 
to a considerable extent. Goitre may sometimes be favorably 
affected by thyroid, and the variety in which it is most bene- 
ficial is that known as the hyperplastic follicular. Complete 
disappearance is exceptional, but as a rule considerable de- 
crease takes place, especially in the young. As recurrence is 
otherwise almost certain, the remedy must be continued indefi- 
nitely. In exophthalmic goitre it generally seems to be injuri- 
ous, rather than beneficial. In sporadic cretinism excellent 
results are often obtained with it, and the brain symptoms share 
in the general relief afforded. Poorly developed young chil- 
dren are often benefited by it. In a few instances of imbecility 
in children, of tetany, and of climacteric insanity much im- 
provement is reported to have been caused by it. In cases of 



SUPRARENAL GLAND. 949 

arterio-sclerosis where nitroglycerin in small doses is of value 
to reduce such disturbances from high tension as dizziness, 
sleeplessness and headache, thyroid has been found of marked 
benefit. It must be used with some caution in persons suffer- 
ing from organic disease of the heart. It has been observed 
in feeding thyroid for other purposes that not infrequently 
menorrhagia is produced, and it is asserted that in delayed 
menstruation, with or without anaemia, no drug is as efficient 
in causing normal menstruation as thyroid extract, given in 
.20 gm. (3 gr.) doses thrice daily. It has been given with 
success in chronic eczema and some other skin diseases, but the 
effects are by no means always permanent. This remedy has 
been advised and considerably employed in the treatment of 
obesity, but as it is not as efficient as some other means, and as 
its continued use in these cases is not unattended with danger, 
it is not to be commended. 

Iodothyrin, a substance isolated from thyroid which possesses 
all the physiological properties of the gland extract, is now 
used to a considerable extent. A milk-sugar triturate of this 
is given in daily dose of 1 to 2 gm. (15 to 30 gr.). 

Poisoning. — A condition somewhat resembling exophthalmic 
goitre in its symptoms, though without exophthalmos or in- 
crease in the size of the thyroid, and known as Thyroidism, 
may be induced by over-doses. Very large doses taken for a 
long time make patients thin; and also produce degeneration 
of the cardiac muscle, so that permanent disability may result. 
Surgeons are especially liable to make this error. 

SUPRARENAL GLAND. 

GLANDULE SUPRARENALES SICC^.— Desiccated Suprarenal 
Glands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparation. 
Adrenalinum. — Adrenalin. 



950 PHARMACOLOGY AND THERAPEUTICS. 

Action of Suprarenal Gland. 

The principal effects of suprarenal gland, as demonstrated 
by experiment, are to increase the tone of all muscular tissue, 
mainly if not entirely by direct action, to constrict the small 
arteries through its action on the vaso-motor centre, and to 
raise blood-pressure more than any other known substance. 
Its action on the circulation is thus exactly the opposite of 
thyroid. The rise in blood-pressure is immediate, but it is to 
be noted that this effect is very brief, lasting less than a min- 
ute, and that it is not elicited at all when the administration 
is by the stomach. Suprarenal is a strong cardiac stimulant. 
The pulse-rate is slowed from stimulation of the pneumogastric 
centre in the medulla oblongata, and the heart muscle is affected 
in the same way as by digitalis, its systole being much strength- 
ened and its diastole being often rendered less complete. The 
heart becomes more and more slowed, and is finally arrested in 
systole. The cardiac stimulation is not produced for some 
time after the constriction of the vessels. Additional actions 
of this substance are a depression of the respiratory centre, 
which may result in respiratory failure and death, and a dimin- 
ution of peristalsis through peripheral action on the nervous 
mechanism. Its action on the muscles strongly resembles that 
of veratrine. 

Certain unfavorable clinical results have been noticed to be 
coincident with the use of suprarenal solutions, and have been 
attributed to their effect. These doubtful results are stated to 
be: haemorrhage, reactionary symptoms, swelling and localized 
areas of oedema, retarded healing, sloughing, and unhealthy 
condition of wounds. Hence, with a view to determine the 
effect of suprarenal preparations on living protoplasm, a series 
of experiments was recently undertaken, and the main results 
of these, with the deductions, drawn from them, have been 
given as follows : 

It seems fair to conclude that solutions in the strength of 
o.ooi interfere with the phenomena of clotting of blood in 
some of the cold-blooded animals (asteria and limulus), but 



SUPRARENAL GLAND. 95 I 

that in other animals there is no change. If these results can 
be applied to warm-blooded animals we may assume that the 
active principle of suprarenal gland has no effect upon the 
coagulation phenomenon, and that the danger of secondary 
haemorrhage from softening of the clot is not increased by 
its use. 

In the egg of the arbacia (sea-urchin) strong adrenalin solu- 
tions may kill the protoplasm, while weaker solutions have a 
marked and regular effect in preventing the cell-division and 
development of the egg. At a certain stage in the cell-division 
the protoplasm is changed, so that it never develops further. 
From these effects on the sea-urchin's egg it seems fair to 
assume that the same effects may be active in the human indi- 
vidual, since the properties of protoplasm are much the same 
wherever it is found. If this be true, then we may assert that 
suprarenal preparations have a marked effect on cell-division 
of healing tissue and upon the proliferation of cells constitut- 
ing granulation tissue. It may also be assumed that these solu- 
tions will have an effect depending on the strength of the solu- 
tion, as well as the duration of the exposure, and that it is 
possible to kill cells or to prevent their activity, or retard cell- 
division. In this connection it should be remarked that other 
substances, especially alkaloids (atropine and aconitine), seem 
to act similarly. As it was also shown that the rate of pro- 
gression of the moving ciliated ovum was much slower in cases 
that were developed in weak solutions, it would appear that the 
vitality of the protoplasm is weakened by suprarenal solutions. 

The cilia of the aronicula larvae are affected only by stronger 
solutions than are necessary to paralyze muscle movement. By 
these the ciliated movement is markedly retarded. In inter- 
preting these results we again see a clear line of demarcation 
drawn between the strength of solutions; these slight differ- 
ences show a potentiality which we would not suspect. 

It would seem that the cilia on the gill of the salt-water clam 
are more resistant to the effect than those of the arbacia or 
aronicula, and this we might expect in an adult animal. When 



952 PHARMACOLOGY AND THERAPEUTICS. 

the oesophageal membranes of a frog are placed in a solution 
of o.oooi the immediate effect is to produce a slowing in the 
ciliated movement. These cilia are also more resistant to the 
effect of this solution than the arbacia or aronicula, and it has 
not been found possible to entirely check the action of the cilia 
with solutions of o.ooi. 

Experiments on the hearts of turtles and frogs show that 
suprarenal solutions are powerful muscle stimulants. 

In the medusa the suprarenal alkaloid is a powerful stimu- 
lant to contraction, and it affects the contractile tissue in a 
most characteristic and marked way. It was found that this 
animal reacted best in a solution of the strength of 0.0005. 

There is therefore warrant for asserting that, at least in the 
lower animals studied in these experiments, suprarenal prepa- 
rations have a most marked influence in interfering with the 
power of cell-division, the development of protoplasm, and the 
movement of cilia, and also in stimulating contractile tissue. 

Therapeutics of Suprarenal Gland. 
It may be used as a local vaso-constrictor in minor surgery. 
On account of this property it may be applied to inflamed tis- 
sues so that these may be rendered anaesthetic by cocaine. For 
topical application, a filtered, freshly-made aqueous solution 
should be employed. It may be sterilized by heat without de- 
stroying its active principle. All antiseptics, used as preserva- 
tives, are disappointing. The active principle has been iso- 
lated by Abel, who proposed the name epinephrin for it. Its 
salts produce an exceedingly powerful effect on blood-pressure. 
The gastric contents, it is found, have no effect upon the ex- 
tract. For internal treatment it is well to commence with .06 
gm. (1 gr.) of the powder, three times a day, and progressively 
increase the dose. It should be given dry on the tongue and 
swallowed without water. It should never be given hypoder- 
matically on account of the collapse which it causes when ad- 
ministered in this way. It is of great value in the treatment of 
" hay-fever," given internally and also applied locally. It is 



THYMUS EXTRACT. 953 

useful in the treatment of acute and chronic bronchitis, bron- 
chial asthma, congestion and oedema of the lungs, haemoptysis, 
and oedema of the glottis. It may be cautiously used in dis- 
eases of the heart, which, as has been stated, it stimulates from 
direct action on the heart muscle. Suprarenal has been used to 
a considerable extent in the treatment of Addison's disease, but 
without much benefit. It might perhaps be of service if it 
could be brought into the blood directly, but its intravenous 
injection would be quite unjustifiable in this affection. In 
shock it has been proposed to inject a solution of one of the 
suprarenal preparations drop by drop into a vein, timing the 
rapidity of the injections by the behaviour of the pulse. 

Adrenalin is the name proposed by Takamine for a sub- 
stance which he has isolated from the suprarenal gland. This 
is employed in a i per mille solution as a local astringent. 

Unofficial Preparation. 
Extractum Thymiamum. — Thymus Extract. Dose, .20 to 
.30 gm.; 3 to 5 gr. 

Action of Thymus Extract. 
As the thymus gland atrophies in childhood and disappears 
after puberty, it is probable that it performs some important 
function in the development and growth of the young child. 
From the fact that it is so active during the period of greatest 
bone growth of the body, it has been inferred that it is con- 
cerned in the formation of bone salts; and a comparison of 
the salts found in the gland with those distributed in the 
bones lends color to this view. The thymus contains a larger 
amount of nuclein, and hence of phosphorus, than any other 
of the glands, and thymus extract is believed to be a recon- 
structive. It has some coagulant action on blood, and in 
this connection the statement which has been made that the 
thymus gland has been found absent in cases of haemophilia is 
of interest. In dogs, after injections of the watery extract 
into the circulation, there have been observed lowering of the 



954 PHARMACOLOGY AND THERAPEUTICS. 

blood-pressure with acceleration of the heart's action, and this 
fall was not prevented by section of the vagi or by paralyzing 
them with atropine. It is thought probable that, as in case 
of thyroid extract, this effect is due to the organic extractive 
and mineral salts present, and not to any active principle. 
With large injections toxic effects have been produced, espe- 
cially in young animals; the phenomena observed being agita- 
tion, intense dyspnoea, collapse, and finally death. In the study 
of the effects of extirpation of this gland, it has been shown 
that in many animals the thymus is not essential to life. Some 
experimenters have found no bad effects whatever resulting, 
while others have observed extreme voracity with emaciation 
for some time after the removal; the animals after one or two 
months recovering their normal condition. It is stated that as 
a result of the operation there have been noted an increase of 
the leucocytes and a diminution of the red corpuscles of the 
blood, and that nutritional changes have been the more marked 
the younger the animal. Among the morbid conditions in 
which a persistent and sometimes a large thymus has been 
observed are exophthalmic goitre, acromegaly, acute leucocy- 
thaemia and, more rarely, simple goitre. 

Therapeutics of Thymus Extract. 
It would seem to be indicated in rickets, haemophilia and the 
scurvy of children. In the latter affection, as the blood is 
evidently inadequately supplied with its requirements, it is 
thought likely that it is the thymus gland that cannot get the 
salts which it needs; this being the cause of the bleeding and 
other symptoms of that condition. Fairly good results have 
been reported from its use in goitre, and it is possible that 
these may have been due to the fact that in the thymus there 
are traces of an iodine-containing compound similar to the iodo- 
thyrin of the thyroid. In exophthalmic goitre (Graves' disease) 
the results have not been so satisfactory, though many cases 
are stated to have improved under its use. One observer, after 
an extensive trial of it, concludes that the thymus gland admin- 



PITUITARY EXTRACT. 955 

istered internally has no specific action in this affection, hav- 
ing no direct effect on the goitre, the heart, or the exophthalmos, 
though it possibly has some value in improving the general 
condition of the patients, and in this way may contribute 
towards their recovery. He publishes the results of the 
treatment of twenty cases, comparing them with twenty cases 
treated in other ways. In pulmonary tuberculosis it has been 
found by some to aid the hygienic and medical treatment, its 
employment being based on the ground that the earthy salts 
of the bones are necessary to permanently encapsulate or heal 
tuberculous lung lesions. One clinician reports, however, that 
while in five out of six carefully selected cases of apyretic 
phthisis an increase in weight occurred during the first weeks 
of treatment, the gain was followed by a loss; otherwise there 
was no change in the general condition. Thymus has also 
been given for haemoptysis. A few cases have been reported 
in which it has appeared to do good in chlorosis, and it has 
been given with benefit in malnutrition and in defective devel- 
opment in children. Thus, it is said to be useful in pseudo- 
hypertrophic paralysis, and other conditions in which it has 
been recommended are leucocythaemia and idiopathic and per- 
nicious anaemia. 

Unofficial Preparation. 
Extractum Pituitarium. — Pituitary Extract. Dose, .20 to 
.30 gm.; 3 to 5 gr. 

Action of Pituitary Extract. 
The function of the pituitary secretion in the body is some- 
what uncertain. Pituitary substance slightly stimulates the 
heart and constricts the blood-vessels, but is greatly inferior 
to suprarenal in this respect. Other effects which have been 
observed after subcutaneous injection in small animals are 
quickened respiration and paralysis of the hind limbs. The 
pituitary body is thought to be always hypersecreting in the 
condition of giantism and is stated to be always diseased in 
acromegaly. In cases of the latter when this secretion be- 



956 PHARMACOLOGY AND THERAPEUTICS. 

comes disturbed there results almost continuous headache, 
sometimes excruciating in character. 

Therapeutics of Pituitary Extract. 
It has been used chiefly in acromegaly, and sometimes with 
good results. Of thirteen cases collected in which it was em- 
ployed, in seven varying degrees of improvement were re- 
corded, in five there was no benefit, and in one the treatment 
appeared to make the patient worse. In one case where there 
was marked improvement this extract was given in combina- 
tion with thyroid. In a number of instances the severe head- 
aches accompanying acromegaly have been relieved by the 
administration of pituitary extract. It has been proposed to 
feed it to young dwarfs. 

Unofficial Preparation. 
Extractum Mammarium. — Mammary Extract. Dose, .20 to 
.30 gm.; 3 to 5 gr. 

Action of Mammary Extract. 
It is believed to have some influence on the uterus, though its 
action is not well understood. 

Therapeutics of Mammary Extract. 
It has been given with alleged good results in uterine fibroma 
and carcinoma, also in menorrhagia, dysmenorrhea and en- 
larged, sensitive uterus. In too frequent menstruation, and par- 
ticularly in chlorotic girls, there is no remedy which acts so 
satisfactorily (delaying the period to the regular time) as mam- 
mary extract. It should be given for five or six days before the 
expected period. 

Unofficial Preparation. 
Extractum Ovarianum. — Ovarian Extract. Dose, .20 to .30 
gm.; 3 to 5 gr. 



TESTICULAR EXTRACT. 957 

Action of Ovarian Extract. 
But little is known of its pharmacological action. Fresh 
ovarian extract is said, when injected into the circulation in 
rabbits, to raise the blood-pressure, diminish the heart's action, 
and slow the respiration, and when administered to the human 
female also to increase the arterial tension. In the castrated 
animal it is found to increase oxidation to somewhat above 
the normal degree, but on the normal animal it has no such 
effect. Its administration does not prevent atrophy of the 
uterus after removal of the ovaries. 

Therapeutics of Ovarian Extract. 
Some time since it was suggested in cases of removal of the 
ovaries, and it has been given with more or less success in the 
various conditions following the functional loss of these organs, 
either through operation or disease. It has been employed 
to relieve congestion and ovarian neuralgia, and may be used 
when the functions of the ovaries are either partially or wholly 
arrested. It is reported to have a decidedly beneficial action 
not only upon typical climacteric disturbances, but also upon the 
psychical depression and constitutional affections, such as gout 
and psoriasis, which may make their appearance at this period. 
In five cases of epilepsy which appeared to be connected with 
the climacteric or with amenorrhcea much benefit is said to 
have been derived from its use. It has been employed in 
delayed or scanty menstruation, ordinary amenorrhcea, uterine 
fibroids, and exophthalmic goitre. 

Unofficial Preparation. 
Extractum Testicularium. — Testicular Extract. (Testicular 
juice.) Dose, .20 to .30 gm.; 3 to 5 gr. 

Action of Testicular Juice. 
The theory has been advanced that certain organs supply to 
the body a natural ferment which is essential to health. When 
this ferment is absent the vital forces degenerate. Under the 



95 8 PHARMACOLOGY AND THERAPEUTICS. 

use of testicular juice the functions of organic life are per- 
formed with new vigor. 

Therapeutics of Testicular Juice. 
Favorable reports of its use in many hundreds of patients 
suffering from organic nervous diseases are on record, but 
the claims are so broad that further observations are necessary. 

Unofficial Preparation. 
Extractum Cerebralum. — Brain Extract. Dose, .20 to .30 
gm.; 3 to 5 gr. 

Action of Brain Extract. 
Febrile reaction, prostration, and in some cases cardiac 
weakness, have followed its administration. 

Therapeutics of Brain Extract. 
It has been made use of for the treatment of various nervous 
disorders, and excellent, although not always constant, results 
have been claimed. 

Unofficial Preparation. 
Extractum Splenicum. — Splenic Extract. Dose, .20 to .30 
gm.; 3 to 5 gr. 

Action of Splenic Extract. 
Excision of the spleen, or the serious impairment of its func- 
tions by disease, it is stated, is usually followed by marked tis- 
sue changes and great susceptibility to alterations of tempera- 
ture, especially in malarial subjects. Scarcely anything is 
known of the action of splenic extract. According to some ex- 
perimenters its subcutaneous injection produces no physiolog- 
ical effects, while others have found that in the dog intravenous 
injections cause first a prompt fall of blood-pressure, followed 
later by a pronounced and continuing rise, which again is suc- 
ceeded by a slow return to the normal. It has been found 



SPLENIC EXTRACT. 959 

that if it is given by the mouth in sufficient amount to produce 
effect it is apt to violently disturb the digestion and cause 
much pain, nausea and vomiting, and that administered hypo- 
dermatically it frequently causes marked local irritation and 
sometimes abscesses. 

Therapeutics of Splexic Extract. 

In various disorders of the blood it has been employed with 
the idea of supplying to that fluid some material which may 
be required for its healthy condition. It has been pointed out 
that the possession of bacteriological power by some secretion 
of the spleen is indicated by such facts as the evident incom- 
patibility of tuberculosis and malaria and by the enlargement 
of the spleen in acute infectious diseases, as though working 
against the germs of such affections. Accordingly, it was pro- 
posed that the splenic substance of animals immune against 
certain of these diseases, such as tuberculosis, malaria and ty- 
phoid fever, should be employed as a remedy in them. Splenic 
extract has been given with more or less benefit in exophthalmic 
goitre, and is stated to have improved the mental, as well as 
the general condition, of the patients in some cases of insanity. 
Like red bone marrow, it has been tried in leucocythsemia, but 
with no great success, and it has been suggested that the reason 
for the failure of these remedies is that in this affection both 
the bone marrow and the spleen are hypertrophied, not 
atrophied. 

Red bone marrow, in addition to its use in leucocythsemia, has 
been given particularly in pernicious anaemia, and also em- 
ployed in the ordinary forms of anaemia and in osteomalacia, 
tuberculous joint diseases, etc. The reports as to the results, 
however, are conflicting, and as a rule these appear to have 
been negative. 

Parotid extract has been used to diminish uterine fibroids 
and in ovarian disease, and is said by some to be practically spe- 
cific in certain forms of dysmenorrhea. 



960 PHARMACOLOGY AND THERAPEUTICS. 

Division XIV —Drugs Acting on Metabolism. 

The action on metabolism of many of the drugs previously 
described has already been referred to. As our knowledge of 
the normal metabolism of the body is as yet very limited, no 
further remarks on this subject need be made except as regards 
the individual drugs now to be considered. In this place it 
may be well to call attention to two names in common use, viz. : 
alterative and tonic. 

Alterative is a vague term which cannot be accurately de- 
fined. It is often employed to cloak our ignorance of the exact 
action of a drug, but in general it is applied to agents which 
appear to modify the nutritive processes and thereby cure or 
alleviate many diseases of chronic type. They thus favorably 
alter morbid processes, as in the case of mercury in syphilis, 
but the modus operandi, of which almost nothing is definitely 
known, probably varies very greatly in the case of different 
drugs. 

Tonic. — A tonic has been stated to be a drug which so influ- 
ences nutrition as to increase the reconstruction or upbuilding 
of the tissue or tissues concerned. While this definition is not 
entirely adequate, it is perhaps as satisfactory as any that can 
be given. 

This division also includes substances used as foods. 

IODINE. 
IODUM.— Iodine. Dose, 0.005 gm. (5 milligm.) ; T ^ gr. 

Preparations. 

1. Liquor Iodi Compositus. — Compound Solution of Iodine. 
(Lugol's Solution.) Dose, 0.2 C.C.; 3 Tl\,. 

2. Tinctura Iodi. — Tincture of Iodine. Dose, 0.1 c.c; 

iy 2 TTL- 

3. Unguentum Iodi. — Iodine Ointment. 



IODINE. 961 

Action of Iodine. 

External. — Iodine is an irritant, disinfectant, and parasiti- 
cide. The first effect of its application to the skin is a yellow- 
ish-brown or dark brown discoloration, which is removable 
by alkalies or sodium hyposulphite. It acts more slowly than 
most other irritants, but on account of its volatility and because 
it precipitates proteids and enters into easily dissociated com- 
pounds with them, its action is both penetrating and prolonged. 
It produces a sensation of heat and itching, accompanied by 
local hyperemia and sometimes by more or less cedematous 
swelling. Some exudation of leucocytes takes place, and the 
strong absorbent action of iodine has been attributed to this. 
Unless used in very concentrated solution or in the solid form, 
which may cause vesication or even corrosion, its irritant action 
is comparatively mild. By repeated applications, however, it 
is possible to secure very pronounced counter-irritation with- 
out the production of a deep destruction of tissue. The super- 
ficial cuticle is usually destroyed, and the skin afterwards ex- 
foliates. As a result of its local application, small quantities 
are absorbed. The subcutaneous injection of solutions of it 
causes intense pain and irritation. The inhalation of the vapor 
of iodine also gives rise to very considerable irritation; excit- 
ing sneezing, coughing and some dyspnoea, with smarting, 
swelling and increased secretion in the nasal mucous membrane, 
conjunctiva, throat and lower respiratory passages. 

Internal. — Iodine naturally exerts its local irritant action on 
the gastro-intestinal tract, causing pain and vomiting, and 
sometimes purging. The drug may be recognized in the vom- 
ited matter and in the stools. In minute doses the slight 
irritation produced on the mucous membrane of the stomach 
may have a somewhat tonic effect, improving the appetite and 
digestion, and be followed by a sedative action. In excessive 
doses it produces marked irritation of the oesophagus and severe 
gastro-enteritis, but death is rarely caused by it. In fatal 
cases of poisoning the mucous membrane of the stomach and 
intestine has been found tumefied and loosened. The irritation 
62 



962 PHARMACOLOGY AND THERAPEUTICS. 

of the alimentary canal may also prove fatal by inducing col- 
lapse and failure of the heart and respiration. In animals 
fatty degeneration of the heart, liver and kidneys has some- 
times been found. Iodine, in the form of iodides and, it may 
be, in a combination with proteids, is rapidly absorbed by the 
mucous membranes generally. Its chief effects after absorption 
are due to its action on the thyroid gland. The symptoms pro- 
duced by its continued administration, such as acceleration of 
the pulse and certain nervous phenomena, are much the same 
as those caused by large amounts of thyroid extract, and are 
thought to be probably due to the excessive production of the 
organic compound, iodothyrin. In the thyroid gland iodine 
exists normally in the form of this substance, and the adminis- 
tration of the drug may lead to an increase in its formation. 
Iodine is excreted, in the form of iodides, chiefly by the kid- 
neys, but also to some extent in the saliva, perspiration, milk 
and bronchial secretion. Free iodine has been detected in the 
stomach, and this is believed to probably result from the de- 
composition of hydriodic acid excreted into that organ. 

Therapeutics of Iodine. 
External. — Iodine preparations are much relied upon as irri- 
tants, counter-irritants and resolvents. The tincture is one of 
the most popular of all external applications. While mild in 
its action, a sufficient effect may usually be secured by the repe- 
tition of its use. The ointment and compound solution are 
also comparatively mild preparations. If a more powerful 
effect is desired, the liniment (B. P., 1885, which contains 
iodine, 5 ; potassium iodide, 2 ; glycerin, 1 ; alcohol, 40) may 
be employed. As it is otherwise liable to cause severe inflam- 
mation, it should be painted on the skin quite lightly, and in 
case it causes much pain it may be washed off with a solution 
of potassium iodide. " Iodine paint " is a tincture twice as 
strong as the official tincture. The conditions for which these 
and other iodine preparations are used are almost innumerable, 
and need not be given in detail. Among them may be men- 



IODINE. 963 

tioned chronic inflammation of joints, periostitis, ringworms, 
enlarged glands, buboes, abscesses, chilblains, pleurisy, and 
inflammation or retraction of the gums. For the last-named, 
what is known as dental tincture of iodine, consisting of 
tincture of iodine, 11, alcohol, 30, is sometimes applied over 
a very circumscribed area. This, or the official tincture, 
may be painted over a spot of tinea or ringworm, and 
the tincture is usually efficacious in tinea versicolor. Other 
preparations used for these parasitic affections are iodized 
collodion (.75 gm. ; 12 gr. ; iodine, dissolved in ether and 
alcohol, to 30 c.c. ; 1 fl. oz. ; of collodion); the liquor (B. P., 
iodine, 10; potassium iodide, 15; water, 200), and Coster's 
paste, which consists of iodine dissolved in light oil of wood 
tar (1 to 4). Tincture of iodine is sometimes of service in 
lupus, and is curative in lentigo and chloasma. Added to salt 
water, it forms a useful wash in chronic ozsena. Two prep- 
arations of iodine are frequently employed in the treatment of 
diseases of women, namely: Churchill's tincture: iodine, 5; 
potassium iodide, 1; water, 8; alcohol, 24; and Battey's fluid: 
iodine, 2; free carbolic acid, 1. A colorless tincture of iodine 
has the advantage of not staining the skin, but is much milder 
than the ordinary tincture. In it iodine is dissolved in alcohol 
and deodorized by a strong solution of ammonia; but it really 
contains no iodine, ammonium iodide and iodate being formed, 
and any irritant affect which it may have is due to excess of 
ammonia. A colorless iodine ointment is also prepared, in 
which the decolorization is effected by means of sodium sul- 
phate. Formerly the practice was much in vogue of injecting 
tincture of iodine into the sac of hydrocele and into cysts, ab- 
scesses, dropsical joints, and the pleural cavity after empyema, 
as well as into other cavities, for the relief of various affections, 
but other methods of treatment have largely superseded this. 
When it is employed, great caution must be observed, as intense 
pain and irritation may be caused, which may possibly be fol- 
lowed by collapse or by suppuration and gangrene. Fatal sys- 
temic poisoning has also been known to result from the injec- 



964 PHARMACOLOGY AND THERAPEUTICS. 

tion of large quantities of iodine into cysts. The same objec- 
tions hold true as regards the parenchymatous injection of the 
tincture in hypertrophied tonsil, goitre, glandular tumors, etc. 
In some cases of spina bifida a successful result may be ob- 
tained by the injection of Morton's fluid, which consists of 
iodine, 1 ; potassium iodide, 3 ; glycerin, 48. 

Internal. — Among the ignorant classes the idea has long pre- 
vailed that seaweed has the effect of reducing obesity, and the 
Fucus vesiculosis, or bladderwrack, has been especially esteemed 
for this purpose. Consequently, it has been made the basis of 
various quack preparations, but any action it may have in this 
regard would seem to be due simply to the interference with 
nutrition caused by the digestive disturbances arising from the 
iodine, chlorine and bromine in its composition. .06 to .12 c.c. 
(1 or 2 m.) of tincture of iodine, largely diluted and repeated 
from time to time, may sometimes have the effect of arresting 
vomiting. Minute doses of the tincture or compound solu- 
tion may also be of service in passive intestinal hemorrhage or 
diarrhoea from atony of the mucous membrane. Goitre, when 
there is present simply a hypertrophy of the gland elements, 
may not infrequently be successfully treated by the internal 
and external use of iodine. For the internal treatment the 
best mode of administration is to give the tincture in small 
doses with potassium iodide, freely diluted. Thyroid extract, 
however, is much more efficient. Iodine has been thought to 
have some curative influence in malarial fevers, but probably 
not much reliance is to be placed upon it. To increase its 
efficiency it has been advised that phenol should be combined 
with it. Thus, .60 to .90 c.c. (10 to 15 R), well diluted, of a 
mixture of the tincture with phenol, in the proportion of 8 to 
1, may be prescribed three times a day; though, as this dosage 
is large, its effects should be carefully watched. A similar com- 
bination has sometimes proved of service in typhoid fever: 
Tincture of iodine, 2; carbolic acid, 1; dose, .06 to .18 c.c. (1 
to 3 m.) three times a day. The compound solution has also 
been employed in typhoid. This preparation has obtained re- 



POTASSIUM IODIDE. 965 

pute as a remedy in scrofulous affections of the skin and of 
the lymphatic glands, especially in syphilitic children, and is 
stated to be useful in some old syphilitic skin diseases attended 
by thickening and scaling. Judiciously employed, iodine prep- 
arations are of some value as inhalations. The vapor of the 
B. P. (tincture of iodine, 1; water, 8; to be gently heated) is 
sometimes prescribed for diseases of the lungs and air-passages, 
but it is too irritating. The following method of inhalation 
has been found beneficial in acute nasal catarrh, " hay-asthma," 
and chronic bronchitis: Tincture of iodine (.30 to .60 c.c. — 5 to 
10 m.) is dropped upon a moistened sponge in a small, wide- 
mouthed bottle, which is placed in a vessel of hot water, and 
the vapor of the iodine is inhaled with that of the water. 
The carbolate (tincture of iodine, 2; carbolic acid, 1) may be 
used instead of the simple tincture of iodine. Camphor is also 
sometimes inhaled with tincture of iodine. In some cases of 
" hay asthma " the local application of the following with a 
post-nasal syringe is of advantage: tincture of iodine, 6; car- 
bolic acid, 1 ; water, 190. The inhalation of iodine and tur- 
pentine has been recommended, as an adjuvant to other meth- 
ods of treatment, in laryngeal and pulmonary tuberculosis. 

1. POTASSII IODIDUM.— Potassium Iodide. Dose, 0.500 gm. 
(500 milligm.) ; iy 2 gr. 

Preparations. 

1. Liquor Iodi Compositus. — Compound Solution of Iodine. 
Dose, 0.2 c.c; 3 HI. 

2. Acidum Hydriodicum Dilutum. — Diluted Hydriodic Acid. 
Dose, 0.5 c.c; 8 n\. 

3. Syrupus Acidi Hydriodici. — Syrup of Hydriodic Acid. 
Dose, 4 c.c; 1 fl. dr. 

4. Unguentum Potassii Iodidi. — Ointment of Potassium 
Iodide. 

2. SODII IODIDUM.— Sodium Iodide. Dose, 0.500 gm. (500 
milligm.); iy 2 gr. 



966 PHARMACOLOGY AND THERAPEUTICS. 

3. AMMONII IODIDUM.— Ammonium Iodide. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

4. STRONTII IODIDUM.— Strontium Iodide. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 

5. ZINCI IODIDUM. — Zinc Iodide. Dose, 0.065 gm. (65 
milligm.); 1 gr. 

Unofficial Preparation. 
Rubidii Iodidum. — Rubidium Iodide. Dose, 0.30 to 1.20 
gm.; 5 to 20 gr. 

Action of the Iodides. 

External. — None. Iodides in watery solution are not ab- 
sorbed from the unbroken skin, but are rapidly absorbed from 
mucous membranes. 

Internal. — The effects produced by the iodides appear to vary 
very considerably, not only in different individuals, but also in 
the same individual at different times, and their mode of action 
is still a matter of great uncertainty. It is recognized, how- 
ever, that they are capable of causing two distinct kinds of 
effects, one an irritation, in consequence of their salt-action, of 
the alimentary canal, manifested by nausea and vomiting and 
sometimes by diarrhoea, and the other a series of symptoms to 
which the name of iodism has been given. The latter symp- 
toms may be elicited by considerably smaller doses than the 
gastric irritation, but, as a rule, appear only when the adminis- 
tration has been continued for some time, the length of this 
period varying greatly in different instances. The size of the 
dose naturally has some relation to their onset. When admin- 
istered internally the iodides are absorbed unchanged by the 
stomach and intestine, and it is found that they make their ap- 
pearance in the secretions within a very short time. They are 
excreted mainly in the urine, in which they are found as salts; 
also to some extent in the saliva and in various other secretions, 
as those of the nasal mucous membrane and sebaceous glands, 
and in the tears, sweat and milk. By the stomach small amounts 
are eliminated as hydriodic acid and sometimes as free iodine. 






POTASSIUM IODIDE. 967 

No free iodine, however, has been found in the saliva, sweat 
or nasal secretion, and it is stated that no iodine can be de- 
tected in the breath of animals poisoned with iodides. There 
seems to be no question that some of the iodide undergoes de- 
composition in the body, and there is strong ground for be- 
lieving that the symptoms of iodism are produced by the iodine 
thus set free. Support to this view is afforded by the fact that 
repeated doses of iodine sometimes cause symptoms resembling 
those of iodism, and also by the fact that formerly much the 
same therapeutic effects were produced by the internal admin- 
istration of iodine which are now obtained with the iodides. 
As has been stated, free iodine is excreted into the stomach, 
and, furthermore, an organic compound of iodine has been 
found in the hair, muscles, heart, etc., after iodide treatment. 
Various explanations have been offered regarding the forma- 
tion of free iodine from iodides, but as none of the theories 
advanced has as yet been positively demonstrated, they need 
not be given here. Some of the symptoms are thought to be 
probably due to action on the thyroid gland. The urine is gen- 
erally increased by the iodides, although so far as known they 
have no specific action on the kidneys. On the other hand, the 
secretion of milk is diminished. Infants have been known to 
suffer with iodism from being nursed by persons under iodide 
treatment. 

Iodism. — This is induced by all the iodides, and the basic ion 
does not appear to be concerned in the effect. Owing to the 
fact that iodine is more readily freed from it, ammonium 
iodide is said to be more liable than the others to cause iodism. 
The symptoms may be divided into two groups. (1) Very 
commonly there is catarrh of the respiratory passages, which 
commences in the nasal mucous membrane, exciting a profuse 
watery discharge, and extends both upward and downward. 
Accordingly there is conjunctivitis, and severe headache may 
result from the invasion of the frontal sinuses. At the same 
time there is much swelling and irritation about the fauces, the 
tonsils are liable to become inflamed, and laryngitis or bron- 



968 PHARMACOLOGY AND THERAPEUTICS. 

chitis may result. (Edema of the larynx, which unless promptly 
relieved may prove fatal, occasionally occurs. In animals it 
has been shown that the bronchial secretion is increased by 
quite small quantities intravenously injected. Usually some- 
what later, an eruption may appear upon the skin. This most 
commonly consists of erythematous patches, but instead there 
may be papules, which sometimes become pustular, and, more 
rarely, other forms of cutaneous disease. (Edema of the face 
is met with in some instances, and very rarely there is albumin- 
uria. Nervous troubles, neuralgia, singing in the ears, con- 
vulsive movements, disturbed intellection, and rarely atrophy 
of the mammae and testes may be noticed. (2) Iodic cachexia 
(which is characterized by rapid emaciation), severe cardiac 
palpitation, and ravenous appetite occasionally occur as late 
phenomena. The local manifestations of iodism can sometimes- 
be prevented by the administration of alkalies, and hence it is 
thought that the variation of their extent in different persons, 
or in the same person at different times, may perhaps be ex- 
plained by a different degree of acidity. Children appear to be 
less subject to iodism than adults. A tolerance may be estab- 
lished, and not infrequently the symptoms disappear while the 
administration is still being maintained. Although the mani- 
festations may be very severe, a cessation begins soon after the 
treatment is discontinued, and the chewing of pellitory will 
hasten the elimination of iodine in the chronic forms. When 
iodic cachexia has supervened, however, the symptoms may not 
disappear for a considerable time. 

Therapeutics of the Iodides. 
The iodides were largely substituted for iodine in therapeu- 
tics for the reason that they are less irritating to the gastro- 
intestinal tract. Potassium iodide is the one in most general 
use. The iodides are perhaps more extensively employed than 
any other of the salts of the alkalies. The most conspicuous 
of their applications is in the treatment of syphilis, in which 
their very great value has long been established. It is in the 



POTASSIUM IODIDE. 969 

third stage of the disease that they produce results which can- 
not be accomplished by any other means; often causing the 
rapid absorption of nodes, gummata and other deposits. In 
order to secure the best effect it is necessary to give very large 
doses in many instances, so that 8, 12 or even 16 gm. (2 to 4 
dr.) may be taken in a day. In syphilis of the nervous system 
large doses are especially called for, and daily amounts of 30 
gm. (1 oz.) are not infrequently required in these cases. No 
symptoms of iodism are likely to appear until the disease sub- 
sides. What is known as the " mixed treatment " is often re- 
sorted to in syphilis, and it is believed by the majority of prac- 
titioners to be especially effective in the intermediate period, 
when the secondary stage is passing into the tertiary. This 
consists of the combination of potassium iodide with corrosive 
mercuric chloride; as a result red mercuric iodide is formed and 
dissolved in the excess of potassium iodide. It has been sug- 
gested that in syphilis the iodides may act as a specific poison 
(antiseptic) to the unknown cause of the disease, but if this 
were so it seems reasonable to suppose that they would be 
much more efficacious in the early stages than is the case. 
Their remedial action remains in fact as yet unexplained. In 
various troubles not directly attributable to syphilis, but occur- 
ring in those who have at one time had the disease, iodides are 
often beneficial. 

While these drugs are of little value in acute rheumatism, 
they are relied upon to some extent in chronic rheumatic mani- 
festations. Rheumatoid arthritis would seem to be more 
amenable to the long-continued use of ferrous iodide than of 
the potassium salt, which is more commonly employed for its 
relief. In any affection in which the administration of the 
iodides must be maintained for a great length of time it will 
usually be found advantageous to allow occasional intermis- 
sions. In so-called gonorrhceal rheumatism the syrup of hy- 
driodic acid is preferable to potassium or other iodide. In sub- 
acute catarrh of the duodenum and of the biliary ducts com- 
paratively small doses of sodium or ammonium iodide may be 



970 PHARMACOLOGY AND THERAPEUTICS. 

of service, and it is asserted that the latter, especially when 
combined with arsenic, is one of the best remedies for the first 
stage of cirrhosis of the liver. Some good results with potas- 
sium iodide have been obtained in aneurism, but whether it has 
any effect in cases where there is no syphilitic taint seems 
doubtful. The iodides are not infrequently useful in promot- 
ing the absorption of inflammatory products, as, for instance, 
in joint disease, pleurisy and catarrhal and fibrinous pneumo- 
nia; and there is reason to believe that their prolonged use in 
sufficient dose may be of benefit in arterio-sclerosis, interstitial 
nephritis, and amyloid disease of the kidney and other organs. 
Simple hypertrophy of the spleen may be cured by the internal 
use of the iodides and the external application of iodine paint 
or ointment of red mercuric oxide, and ammonium iodide is 
often efficacious in removing the enlargements of the spleen 
and liver caused by malarial disease. Iodides have long been 
employed in the treatment of goitre, but now seem likely to be 
entirely supplanted by thyroid extract. Ammonium iodide is 
highly esteemed in capillary and in chronic bronchitis, and 
potassium iodide is sometimes quite efficacious in relieving the 
symptom asthma. For the internal treatment of " hay asthma " 
it should be given in full doses, and it may be advantageously 
combined with arsenic. The iodides have been recommended 
in various cerebral affections, but unless these are of syphi- 
litic origin, not much is probably to be expected from their use. 
Potassium iodide is occasionally prescribed to diminish the 
secretion of milk. This salt is commonly given to promote the 
elimination of lead and mercury in cases of chronic poisoning 
from these metals, though experiments appear to indicate that 
it is not more efficient in this regard than the chloride or bro- 
mide. The iodide treatment is sometimes of service in non- 
syphilitic skin diseases. It is regarded as especially useful in 
actinomycosis and psoriasis. In many of the conditions in 
which potassium iodide is employed, particularly when the ad- 
ministration is long-continued, it would seem that sodium iodide 
should be preferred, as it does not occasion so much depression. 






GOLD AND SODIUM. CHLORIDE. 97 1 

Rubidium iodide (not official), which, it is asserted, is better 
borne than the potassium salt, has been proposed as a substi- 
tute for potassium iodide. 

Strontium iodide has been recently introduced, and is used 
for the same purposes as the other iodides. It is believed that 
it is less likely to disturb the stomach, cause acne, and depress 
the heart than the remaining iodides. In many instances the 
syrup of hydriodic acid can be substituted with advantage for 
the iodides. It is not so likely to produce iodism, nor does it 
so readily give rise to the " iodide punishment." Its pleasant 
taste is grateful to most patients, and it should be admin- 
istered, well diluted, one-half hour before meals, or at least 
upon an empty stomach. Some of the commercial preparations 
are likely to decompose readily, especially when made from 
tartaric acid and potassium iodide, and are objectionable from 
the amount of syrup which is administered when large doses 
are employed. 

GOLD. 

AURI ET SODII CHLORIDUM.— Gold and Sodium Chloride. 

gr. 

Action of Gold and Sodium Chloride. 
In small doses gold and sodium chloride is supposed to pro- 
mote appetite and digestion, to stimulate the functions of the 
brain and to be an aphrodisiac. Full doses cause nausea and 
vomiting, and finally impair nutrition. The toxic symptoms 
resemble those of poisoning by corrosive mercuric chloride. 

Therapeutics of Gold and Sodium Chloride. 
It is useful in irritative dyspepsia, gastro-duodenal catarrh, 
hypochondriasis, and also chronic ovarian irritation and ovari- 
tis, as well as in chronic albuminuria, hepatic sclerosis, and 
granular kidney, since it prevents hyperplasia of connective 
tissue. It is a valuable remedy in the tertiary manifestations 
of syphilis, especially of the bones, and presents fewer disad- 
vantages than corrosive mercuric chloride. 



972 PHARMACOLOGY AND THERAPEUTICS. 

GUAIAC. 

GUAIACUM (Guaiaci Resina, U. S. P., 1890).— Guaiac. (Gum 
Guaiac.) Dose, 1 gm.; 15 gr. 

Preparations. 
Tinctura Guaiaci.— Tincture of Guaiac. Dose, 4 c.c; 1 fl. dr. 

Tinctura Guaiaci Ammoniata. — Ammoniated Tincture of 
Guaiac. Dose, 2 c.c; 30 TT1. 

Unofficial Preparation. 
Guaiaci Lignum (U. S. P., 1890). — Guaiacum Wood. 
(Lignum Vitae.) Dose, 1 to 4 gm.; 14 to 1 dr. 

Action of Guaiac. 

External. — The tincture of guaiac is used for the detection 
of blood stains. 

Internal. — Guaiacum is diaphoretic, expectorant and laxa- 
tive, and in large doses a gastro-intestinal irritant, pro- 
ducing vomiting and purging. When it fails to act on the 
skin it is apt to cause free diuresis. In moderate amount it 
increases the flow of saliva and occasions a feeling of warmth 
in the epigastrium, and in its local effects on the stomach and 
reflex stimulation of the heart it resembles the volatile oils. It 
is thought to probably have a slight antiseptic action as regards 
the alimentary canal and the secretions, and when taken in 
small doses for some time is said to favorably affect metabolism. 
It is also considered to have emmenagogue properties. In some 
individuals a skin rash is produced by it. 

Therapeutics of Guaiac. 
Internal. — Guaiacum is so disagreeable and its therapeutic 
value rests on such a slender basis that it is not very often 
prescribed. Its effectiveness in many chronic and obscure 
complaints, it has been observed, no doubt correctly, is due 
partly to its purgative property and partly to its nastiness, a 
quality which is highly appreciated by many patients. Prob- 



PRICKLY ASH. 973 

ably its most useful application is in the treatment of tonsillitis, 
where in doses of 2 c.c. [}/& fl. dr.) given in emulsion or yolk of 
egg every four hours, it often serves to abort the disease, or at 
all events to reduce the inflammation. In chronic sore-throat 
it is also sometimes of service, and, it is said, more particularly 
in patients who have had syphilis. It is preferably used here 
in the form of lozenges (.20 gm. ; 12 gr. of the resin with a fruit 
basis). The ammoniated tincture may be employed as a gar- 
gle. On account of its purgative properties, guaiac has been 
given in habitual constipation. Malt extract is a good vehicle 
for it, or it may be prescribed in a pill in combination with 
other remedies. It is practically useless in syphilis and chronic 
rheumatism, for which it was at one time largely prescribed. 
It is thought by some to be of benefit in warding off attacks of 
gout. Doses of .75 gm. (12 gr.), taken in wafers and followed 
by effervescent lithium citiate, are recommended, and it is ad- 
vised that the treatment should be maintained indefinitely. The 
mixture of the B. P. (Guaiacum resin, 6; sugar, 6; tragacanth, 
1; cinnamon water, 240; dose, 15 to 30 c.c; ^ to 1 fl. oz.) is 
said to be a more efficient preparation than the tincture. 

PRICKLY ASH. 

XANTHOXYLUM.— Xanthoxylum. (Prickly Ash Bark.) Dose, 
2 gm.; 30 gr. 

Preparation. 
Fluidextractum Xanthoxyli.— Fluidextract of Xanthoxylum. 
Dose, 2 c.c; 30 nt. 

Action of Prickly Ash Bark. 
Xanthoxylum has about the same action as guaiac. It pro- 
duces, when swallowed, a sensation of heat. 

Therapeutics of Prickly Ash Bark. 
It enjoys some reputation as a remedy for chronic rheuma- 
tism, and has been used in syphilis and chronic hepatic dis- 
orders. For patients suffering from chronic syphilis who do 



974 PHARMACOLOGY AND THERAPEUTICS. 

not tolerate either mercury or the iodides, McDade's formula 
may be employed. This is equal parts of the fluidextracts of 
sarsaparilla, stillingia, lappa, and phytolacca and of tincture of 
xanthoxylum. The dose is from 4 to 15 c.c. ; 1 to 4 fl. dr., 
thrice daily. The bark, used as a masticatory, is a popular 
remedy for tooth-ache. 

ICHTHYOL. 

Unofficial Preparation. 

Ichthyol. — Ichthyol. (Ammonium Ichthyol-Sulphonate.) 

Dose, 0.60 to 1.20 gm.; 10 to 20 gr. 

Action of Ichthyol. 
Ichthyol is an active reducing agent. It has some antiseptic 
property and it is mildly irritant to the skin, from which a 
certain amount of absorption takes place when it is rubbed in. 
In large doses it produces gastro-intestinal irritation. It is 
excreted by the kidneys and also, it is believed, by the intestine. 

Therapeutics of Ichthyol. 
It is used chiefly as a local application in skin diseases, espe- 
cially chronic eczema and psoriasis. For acne rosacea ichthyol 
paste is recommended (starch, 40; moisten with water, 20; 
rub in ichthyol, 40, and then a strong solution of albumin, 1 or 
more). In erysipelas in which it is thought to be of con- 
siderable service, an ointment composed of lanolin and ichthyol 
(20 to 50 per cent.) may be applied. Ichthyol has also been 
used for ulcers of the leg and for burns, and in the form of a 
suppository for chronic prostatitis. Combined with glycerin 
(1 to 10) it is employed in gynaecological practice. It has been 
advised as an application over inflamed and rheumatic joints, 
indurated glands and swellings, as well as for chronic inflam- 
mations of the pelvic viscera, and is said to cause the absorp- 
tion of inflammatory products. Internally it has been given in 
capsules or pills (in dose from .60 to 2 gm. ; 10 to 30 gr.) for 



SARSAPARILLA. 975 

a variety of chronic affections, including rheumatism, syphilis 
and pulmonary disease, but it seems doubtful whether it is of 
any practical value. Under the name of Thiol, a mixture of 
sulphuretted hydrocarbons has been used as a substitute for 
ichthyol, because it is less offensive. It has been applied as an 
ointment in vaseline (i to '8). 

SARSAPARILLA. 
SARSAPARILLA. — Sarsaparilla. Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Sarsaparillae. — Fluiciextract of Sarsapa- 
rilla. Dose, 2 c.c; 30 m,. 

2. Fluidextractum Sarsaparillae Compositum. — Compound 
Fluidextract of Sarsaparilla. Dose, 2 C.C.; 30 TTL- 

3. Syrupus Sarsaparillae Compositus. — Compound Syrup of 
Sarsaparilla. Dose, 16 C.C.; 4 fl. dr. 

Unofficial Preparation. 

Decoctum Sarsaparilla Compositum (U. S. P., 1890). — 

Compound Decoction of Sarsaparilla. Dose, 30 to 1.20 C.C.; 
1 to 4 fl. oz. 

Action of Sarsaparilla. 
Sarsaparilla is not known to have any physiological action. 

Therapeutics of Sarsaparilla. 
It is apparently useful only as a vehicle. On account of its 
containing an acrid glucoside similar to saponin it should be 
administered with some care, as intestinal ulceration has been 
attributed to its prolonged use. 

INDIAN SARSAPARILLA. 

Unofficial Preparations. 
Hemidesmus. — Hemidesmus. (Indian Sarsaparilla.) 
Syrupus Hemidesmi. — Syrup of Hemidesmus. Dose, 2 to 4 



gy6 PHARMACOLOGY AND THERAPEUTICS. 

Action of Indian Sarsaparilla. 
Hemidesmus has been described as diaphoretic, diuretic and 
alterative, but, like sarsaparilla, it does not appear to have 
any distinct physiological action. 

Therapeutics of Indian Sarsaparilla. 
It has been employed for the same purposes as sarsaparilla, 
and in India, where it is chiefly used, the native physicians are 
said to give it for the relief of renal troubles. The syrup con- 
stitutes a pleasant vehicle for other remedies, and this is prob- 
ably the only service that this drug renders. 

SASSAFRAS. 
SASSAFRAS.— Sassafras. Dose, 8 gm.; 120 gr. 
SASSAFRAS MEDULLA.— Sassafras Pith. 

Preparation. 
Mucilago Sassafras Medullae. — Mucilage of Sassafras Pith. 
Dose, 16 c.c.; 4 fl. dr. 

OLEUM SASSAFRAS.— Oil of Sassafras. Dose, 0.2 c.c; 3 HI. 
SAFROLUM.— Safrol. Dose, 0.3 c.c; 5 IT^ 

Action of Sassafras. 

Sassafras has the action of the volatile oils in general. The 
pith is demulcent. 

Safrol, which also occurs in the oils of camphor, star-anise, 
and cinnamon leaves and in various barks, constitutes about 
8o per cent, of the oil of sassafras, and its action is therefore 
practically the same as that of the latter. 

Therapeutics of Sassafras. 
The mucilage is somewhat stimulant in its action, and is 
an excellent vehicle. The infusion, made from the bark (not 
official), is considered highly efficacious in poison oak eruption, 
for which it may be used both internally and locally. 



j 



DULCAMARA. 977 

STILLINGIA. 
STILLINGIA.— Stillingia. (Queen's Root.) Dose, 2 C.C.; 30 gr. 

Preparation. 
Fluidextractum Stillingiae. — Fluidextract of Stillingia. 
Dose, 2 c.c; 30 TTL. 

Action of Stillingia. 
Stillingia is in large doses emetic and cathartic, but in smaller 
ones, alterative. 

Therapeutics of Stillingia. 
It is a valuable remedy in syphilis and in the cutaneous and 
hepatic diseases which are benefited by so-called alterative 
medicines. 

BURDOCK. 

LAPPA.— Lappa. (Burdock.) Dose, 2 gin.; 30 gr. 

Preparation. 
Fluidextractum Lappae. — Fluidextract of Lappa. Dose, 2 
c.c; 30 ttl. 

Action of Burdock. 
Burdock is considered to be a diuretic and a diaphoretic alter- 
ative. 

Therapeutics of Burdock. 
It has been recommended in the treatment of various chronic 
skin diseases, especially in psoriasis and acne. 

DULCAMARA. 

DULCAMARA (U. S. P., 1890).— Dulcamara. (Bittersweet.) 

Dose, 4 to 8 gm.; 1 to 2 dr. 

Unofficial Preparation. 
Extractum Dulcamarse Fluidum (U. S. P., 1890).— Fluid- 
extract of Dulcamara. Dose, 4 to 8 c.c; 1 to 2 fl. dr. 

63 



97 8 PHARMACOLOGY AND THERAPEUTICS. 

Action of Dulcamara. 
Dulcamara increases the secretions, particularly those of the 
kidneys and skin, with some diminution of sensibility. In large 
closes it is an acro-narcotic poison. 

Therapeutics of Dulcamara. 
It has been employed chiefly for cutaneous eruptions, par- 
ticularly of a scaly character, but is seldom prescribed. 

CHIMAPHILA. 
CHIMAPHILA.— Chimaphila. (Pipsissewa.) Dose, 2 C.C.; 30 gr. 

Preparation. 
Fluidextractum Chimaphilae. — Fluidextract of Chimaphila. 
Dose, 2 c.c; 30 Til. 

Action of Chimaphila. 
This plant is diuretic and diaphoretic. 

Therapeutics of Chimaphila. 
It is used for rheumatism and nephritic affections. 

MARIGOLD. 

CALENDULA.— Calendula. (Marigold.) Dose, 1 gm.; 15 gm. 

Preparation. 
Tinctura Calendulae. — Tincture of Calendula. 

Action of Marigold. 
Marigold was formerly supposed to be antispasmodic, sudo- 
rific and emmenagogue, but now it is believed to have no thera- 
peutic value. 

Therapeutics of Marigold. 
The tincture has been employed topically to promote the heal- 
ing process in wounds, burns, ulcers, etc. 



RHUS TOXICODENDRON. 979 

SCUTELLARIA. 
SCUTELLARIA.— Scutellaria. (Skullcap.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Scutellariae. — Fluidextract of Scutellaria. 
Dose, 1 c.c; 15 TT\,. 

Unofficial Preparation. 
Decoctum Scutellariae. — Decoction of Scutellaria. Dose, 30 
to 60 c.c; 1 to 2 fl. oz. 

Action of Scutellaria. 
Scutellaria has little medicinal effect. 

Therapeutics of Scutellaria. 
It is used as a nervous sedative; formerly it was given, in 
decoction, for epilepsy. 

CANADIAN MOONSEED. 

Unofficial Preparations. 
Menispermum (U. S. P., 1890). — Menispermum. (Canadian 
Moonseed.) Dose, 0.30 to 2 gm.; 5 to 30 TTt. 

Extractum Menispermi Fluidum (U. S. P., 1890). — Fluid- 
extract of Menispermum. Dose, 0.30 to 2 C.C.; 5 to 30 TT\.- 

Action of Canadian Moonseed. 
The action of menispermum is similar to that of sarsaparilla. 
Like sarsaparilla, it is probably inert. 

Therapeutics of Canadian Moonseed. 
It has some repute in domestic practice as a " blood purifier," 
but is rarely prescribed in medicine. 

RHUS TOXICODENDRON. 

Unofficial Preparations. 
Rhus Toxicodendron (U. S. P., 1890). — Rhus Toxicodendron. 
(Poison Ivy.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr. 



98O PHARMACOLOGY AND THERAPEUTICS. 

Tinctura Rhois Toxicodendri. — Tincture of Rhus Toxicoden- 
dron. Dose, .006 to .12 c.c; T \ to 2 Ti\.. 

Action of Rhus Toxicodendron. 
Applied to the skin it produces redness and swelling, with 
a vesicular eruption and intense itching, which may spread 
rapidly over the surface of the body. The irritation may ex- 
tend to the mucous membranes, causing conjunctivitis, pharyn- 
gitis, etc. In addition, there may be fever, general rheumatoid 
pains, colic, and diarrhcea with bloody stools. Sometimes there 
is also hematuria. Similar phenomena are said to result from 
its internal administration, but no cases of fatal poisoning have 
been observed from it. Some individuals are so susceptible to 
its influence that the exhalations from the plant will produce 
on them its characteristic effects, while others are not at all 
affected by contact with it or even by chewing the leaves. The 
effects of the drug are partly due to its volatile active principle, 
but also to a fixed oil which it contains, as the dried plant may 
also cause poisoning. The eruption produced by it is followed 
by desquamation. 

Therapeutics of Rhus Toxicodendron. 
The tincture of the fresh leaves has been used in paralysis, 
nocturnal incontinence of urine, and cutaneous diseases; but 
the remedy is dangerous and, probably, a useless one for these 
purposes. Largely diluted it has been used as a lotion for 
bruises and burns. 

COD LIVER OIL. 

OLEUM MORRHU^E.— Cod Liver Oil. (Oleum Jecoris Aselli.) 
Dose, 16 c.c; 4 fl. dr. 

Preparations. 

1. Emulsum Olei Morrhuae. — Emulsion of Cod Liver Oil. 
Dose, 8 c.c; 2 fl. dr. 

2. Emulsum Olei Morrhuae cum Hypophosphitibus.— Emul- 
sion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.; 2 fl. dr. 



COD LIVER OIL. 98 I 

Action of Cod Liver Oil. 

External. — Cod liver oil is emollient to the skin, and when 
rubbed in is absorbed from it. 

Internal. G astro -intestinal Tract. — Cod liver oil, while often 
well borne by the stomach, has, especially in large doses, a 
tendency to cause eructation, nausea and sometimes diarrhoea. 
It is generally believed that it is more rapidly absorbed from 
the intestine than other oils, though the evidence on this point 
is not altogether conclusive. Some authorities attribute this 
supposed superior absorbability to the free acid in the oil, the 
presence of this facilitating saponification and emulsion. While 
this explanation might hold good as regards the old dark- 
colored oils, the pale oil now generally in use is found to 
often contain less free acid than ordinary olive oil. In the 
test-tube, at all events, cod liver oil forms an emulsion more 
rapidly than other oils. 

Tissues. — Cod liver oil reduces the color of a solution of 
potassium permanganate more promptly than other oils, show- 
ing that it is more readily oxidized. As it is a fat which is readily 
absorbed and readily assimilated, its continued ingestion leads 
to a marked increase in weight and strength. It is thus a food 
of the highest value, and it is especially esteemed for the reason 
that many delicate persons who cannot digest ordinary animal 
fats are able to take this. In addition, there is some ground for 
supposing that cod liver oil, aside from its admirable qualities 
as a food, possesses certain peculiar virtues in consequence of 
special elements in its composition. Thus, if it is true, as has 
been stated, that iodine may occur in the proportion of 1 to 
2,000 of the oil, the influence of this remedy is not to be ignored. 
Erythema or acne is sometimes caused by cod liver oil. 

Therapeutics of Cod Liver Oil. 
External. — The external application of cod liver oil by rub- 
bing it into the skin is undoubtedly of considerable value in 
cases of defective nutrition or wasting disease, both in adults 
and children, but the very disagreeable odor of the oil is a 



982 PHARMACOLOGY AND THERAPEUTICS. 

serious objection to its use. In infants the common practice 
has been to apply it simply under the binder, but in order to 
prevent the child from smelling so much of the oil the following 
method is recommended: The patient is stripped and the oil 
applied over the surface of the body, with the manipulations of 
massage, before a warm fire; a blanket is wrapped around him 
and should be kept on for an hour or two; the excess of oil 
is then removed by a warm bath containing a little whiskey or 
bay rum. Inunction with cod liver oil has sometimes been 
practised in the case of adults suffering from chronic dysen- 
tery or scaly skin diseases, and, when other treatment proves 
inadequate, it may be resorted to in children affected with 
chronic skin diseases, marasmus, scrofula, tuberculosis and 
wasting diseases generally. It is regarded as especially ser- 
viceable in the coeliac affection of children characterized by 
suspension of the function of the pancreas. 

Internal. — Cod liver oil is of more value than any other one 
remedy in nearly all varieties of tuberculosis. The following 
conditions are regarded as contra-indicating its use : Diarrhoea, 
whether due to the disease or caused by the oil, severe haemo- 
ptysis, vomiting, aggravated dyspepsia, and high temperature. 
When none of these is present, it is indicated in convales- 
cence from acute disease, especially in children, and in all 
chronic diseases attended with malnutrition and loss of flesh. 
It was first introduced in medicine for the treatment of chronic 
rheumatic affections, and while not now so generally employed 
in these as formerly, it may not infrequently prove of service 
when they occur under bad hygienic influences in cachectic sub- 
jects. It is beneficial in strumous synovitis and in caries and 
necrosis of bone, and both its local and internal use has been 
commended in rheumatic gout with deposits about the joints. 
In diseases of the skin of strumous origin it has been designated 
" our sheet-anchor," and there is no question of its utility in 
tertiary syphilis, chronic bronchitis, emphysema, and various 
chronic affections of the brain and nervous system. It may con- 
stitute a very efficient element in the treatment of neuralgia, 



COD LIVER OIL. 983 

chorea, epilepsy, mercurial tremor, and paralysis agitans, and in 
atheroma of the arteries it has been found useful in combating 
degenerative changes and preventing failure in the nutrition of 
the brain. Here its prolonged administration with phosphates 
or hypophosphites is commended. Cod liver oil is invaluable in 
the treatment of rickets and the wasting diseases of children, 
especially in cases of strumous diathesis, and in these condi- 
tions it may often be given with advantage in association with 
syrup of ferrous iodide. Many infants and young children 
take the undisguised oil with avidity. Older persons, however, 
are apt to object to its unpleasant odor and taste. When such 
objection is made, the oil may be administered in soft capsules 
or in one of the numerous carefully compounded preparations 
to be found in the market. Some patients are able to take the 
oil by rinsing out the mouth with whiskey or brandy before- 
hand, and 6thers by putting a little salt in the mouth after 
swallowing it. To render it less unpalatable .60 c.c. (10 Tl) 
of pure ether or .06 to .12 c.c. (1 to 2 ni) of oil of peppermint 
or cloves may be added to each dose. One part of essential 
oil of eucalyptus to 100 parts of pale oil is said to entirely do 
away with the odor and taste. A very nutritious combination 
in which the taste of the oil is quite well disguised is made by 
rubbing together equal parts of cod liver oil and extract of 
malt. In this, however, the oil is likely to repeat.' Paresi's 
well-known disguise is prepared as follows: To 400 parts of 
cod liver oil are added 10 parts of animal charcoal and 20 parts 
of ground roasted coffee. The mixture is digested in a water- 
bath at a temperature of 50 to 6o° C. (122 to 140 F.), and 
after standing for three days is filtered and put into well- 
stoppered bottles. The oil is also sometimes given in ordinary 
black coffee. The most popular way of taking it is in the form 
of emulsions, and a great variety of these have been suggested. 
The following is advised by the British Pharmaceutical Con- 
ference: Cod liver oil 240 c.c. (8 fl. oz.) ; the yolk of two 
eggs; tragacanth in powder, 1 gm. (15 gr.) ; elixir of saccharin, 
4 c.c. (1 fl. dr.) ; tincture of benzoin, 4 c.c. (1 fl. dr.) ; spirit of 



984 PHARMACOLOGY AND THERAPEUTICS. 

chloroform, 15 c.c. (4 fl. dr.) ; oil of bitter almonds, .50 c.c. 
(8 ni); distilled water to 500 c.c. (16 fl. oz.). The elixir of 
saccharin consists of saccharin, 1.50 gm. (24 gr.) ; sodium 
bicarbonate, .75 gm. (12 gr.) ; alcohol, 4 c.c. (1 fl. dr.); dis- 
tilled water, 28 c.c. (7 fl. dr.). When, as is often the case, 
it is desirable to give iron with cod liver oil the following may- 
be used: Cod liver oil, 15 c.c. (4 fl. dr.) ; iron and ammonium 
citrate, .30 gm. (5 gr.) ; potassium carbonate, .20 gm. (3 gr.) ; 
saccharin, .015 gm. (% gr.) ; oil of caraway, .015 c.c. (*4 1T L) ; 
water to 30 c.c. (1 fl. oz.). The hypophosphites are also some- 
times incorporated in emulsions of the oil. It will be seen that 
emulsions of the oil, with and without hypophosphites, are now 
official preparations. 

EXTRACT OF MEAT. 

Unofficial Preparation. 
Extraction Carnis. — Extract of Meat. 

Action of Extract of Meat. 
Extract of meat is a nutrient and a stimulant. 

Therapeutics of Extract of Meat. 
It is useful in relieving prostration and fatigue. The solu- 
tion seasoned with capsicum is valuable in alcoholic excess and 
delirium tremens. In infantile bowel disturbances, when milk 
must be forbidden, it is often indicated. In phthisis it will fre- 
quently sustain the patient ; in the aged it will support life with- 
out taxing the digestive powers. The amount to be used should 
be regulated by the age and condition of the patient. 

MILK. 

Unofficial Preparations. 
Lac. — Milk. 

Lac Humanum Artificiosum. — Artificial Human Milk. 
Lac Peptonizatum. — Peptonized Milk. 
Kumyss. — Kumyss. 



MILK. 985 

Action of Artificial Human Milk. 
It is designed to produce the effects of human milk, and is 
invaluable as a food for infants whose mothers cannot suckle 
them. 

Therapeutics of Artificial Human Milk. 

Many cases of diarrhoea, indigestion and other ailments 
can be cured by substituting this milk for the usual milk and 
water given to infants. Some manufacturers supply it on 
prescriptions designating the amount of milk sugar, fat, pro- 
teids and salts, which it should contain, but it is cheaper to 
make it at home, and the method of preparing it is easily car- 
ried out. When bought it is often sterilized, or pasteurized, 
and sold in air-tight bottles. It should be remembered that a 
long-continued diet of sterilized milk may, in children, cause 
rickets. 

Action of Peptonized Milk. 

The nutritive value of the peptones has been shown by the 
gain in weight observed in animals in whose diet they were 
made to replace the ordinary proteids, and the same result is 
seen in kittens fed with peptonized milk. The alkaline reac- 
tion of peptonized food has the effect of stimulating secretion. 

Therapeutics of Peptonized Milk. 
It is ordinarily given in any condition in which the stomach 
is incapable of digesting unchanged milk. It is also used where 
it is desirable, as may be the case in typhoid fever, to avoid the 
rapid precipitation of casein in the stomach. Small quantities 
of peptonized milk are sometimes of great service in cases of 
acute febrile diseases in which vomiting is a troublesome symp- 
tom, as also in repeated vomiting from whatever cause. Pep- 
tonized milk and other peptonized foods are especially useful in 
cases in which there is a marked deficiency of the secretion of 
the stomach, as in gastric catarrh, atrophy of the gastric mu- 
cous membrane, and advanced cancer of the stomach. Among 
the numerous other conditions in which they are of service 



986 PHARMACOLOGY AND THERAPEUTICS. 

may be mentioned chronic Bright's disease, pulmonary tuber- 
culosis, and pernicious anaemia, when the digestive function is 
greatly impaired. As a rule, the use of peptonized food should 
be resorted to only as a temporary expedient. Milk is often 
given by the rectum, and when administered in this way it 
should always be peptonized. A nutrient enema which is much 
used consists of the yolk of an egg with sufficient milk to make 
120 c.c. (4 fl. oz.). The mixture may be peptonized in the same 
way as plain milk, and 2 gm. (30 gr.) of common salt should 
be added before the injection is made. 

Action of Kumyss. 
This preparation has the nutritious properties of ordinary 
milk, and, as it contains a small quantity of alcohol, is also a 
mild stimulant. A large amount of carbon dioxide gas is gen- 
erated in kumyss, and great care must therefore be exercised 
in opening the bottles containing it. 

Therapeutics of Kumyss. 
On account of its slightly stimulating quality it is of much 
service in convalescence, in phthisis, and in various other de- 
pressed conditions. It is also used in gastric ulcer and cancer, 
and other diseases of the stomach, and for the same general 
purposes as milk. It is usually more agreeable to the patient 
than the latter, and is often borne by the stomach when all other 
food is vomited. The preparations found in the market are 
very good substitutes for the kumyss drunk by the Tartars, who 
prepare it by fermenting mares' milk. 

Division XV. — Drugs which Have no Marked Therapeutic 
Properties. 
Many of the drugs here presented are official, although some 
have been dismissed from the Pharmacopoeia, and a number of 
them are in daily use in the pharmacies. Their interest to the 
physician lies chiefly in their employment to make prescriptions 
more palatable or sightly. 



BALM. 987 

VANILLA. 

VANILLA.— Vanilla. Dose, 1 gm.; 15 gr. 

Preparation. 
Tinctura Vanillae. — Tincture of Vanilla. 
VANILLINUM.— Vanillin. Dose, 0.030 gm. (30 milligm.) ; 1/2 gr. 

Action of Vanilla. 

Vanillin has been asserted to be locally irritant and to have 
produced in frogs spinal convulsions, followed by paralysis 
affecting both the spinal cord and the motor nerves. Vanilla 
is probably inert as regards any action on the human system. 
There can be little question that the cases of poisoning which 
from time to time have been reported from the eating of ice- 
cream and other articles flavored with vanilla were due to 
ptomaines. 

Therapeutics of Vanilla. 

Vanilla has been suggested as a remedy in hysteria, but it 
is used for the most part simply as a flavoring agent. 

RASPBERRY. 

Unofficial Preparations. 

Rubus Idseus (U. S. P., 1890). — Raspberry. 
Syrupus Rubi Idsei (U. S. P., 1890). — Syrup of Raspberry. 
Dose, indefinite. 

Action of Raspberry. 
Raspberry has no medicinal properties. 

Therapeutics of Raspberry. 
Raspberry syrup is used chiefly as a flavoring agent. 

BALM. 

Unofficial Preparation. 

Melissa (U. S. P., 1890).— Melissa. (Balm.) Dose, 4 to 8 
gm.; 1-to 2 dr. 



988 PHARMACOLOGY AND THERAPEUTICS. 

Action of Balm. 
Balm has no appreciable effects upon the system. 

Therapeutics of Balm. 
It is used as a flavoring agent. 

COCHINEAL. 

COCCUS.— Cochineal. 

Unofficial Preparation. 
Tinctura Cocci (B. P.). — Tincture of Cochineal. Dose, 0.30 
to 1 c.c; 5 to 15 Tn,. 

Action of Cochineal. 
It has been supposed by some to possess anodyne properties, 
but it probably has no action. 

Therapeutics of Cochineal. 
Cochineal is used only as a coloring agent. It was formerly 
employed in the treatment of whooping-cough (in which it had 
a considerable vogue), and of neuralgia. 

SAFFRON. 

Unofficial Preparations. 

Crocus (U. S. P., 1890).— Saffron. Dose, 0.30 to 2 gm.; 
5 to 30 gr. 

Tinctura Croci (U. S. P., 1890). — Tincture of Saffron. Dose, 
4 to 8 c.c; 1 to 2 fl. dr. 

Infusum Croci. — Infusion of Saffron. Dose, freely. 

Action of Saffron. 
Saffron is somewhat aromatic, and is credited with mild anti- 
spasmodic and anodyne properties. 



SESAME. 989 

Therapeutics of Saffron. 
Saffron is used to color pharmaceutical preparations. It has 
sometimes been given as an emmenagogue. A hot infusion, 
known as saffron tea, is a popular remedy in domestic practice 
to promote the eruption in measles and other exanthemata. 
Any diaphoretic influence that it may have is no doubt due 
simply to the hot water. 

RED SAUNDERS. 
SANTALUM RUBRTJM.— Red Saunders. 

Action of Red Saunders. 
Red Saunders is of no value medicinally. 

Therapeutics of Red Saunders. 
It is used only as a coloring agent. 

MYRCIA. 

Unofficial Preparations. 

Oleum Myrcise (U. S. P., 1890).— Oil of Myrcia. (Oil of 
Bay.) 

SpiritUS Myrcise (U. S. P., 1890). — Spirit of Myrcia. (Bay 
Rum.) 

Action of Myrcia. 

Oil of myrcia has the general action of the volatile oils. 

Therapeutics of Myrcia. 
Oil of myrcia is used solely as a perfume. Bay rum is used 
as a refrigerant lotion. 

SESAME. 

Unofficial Preparation. 

Oleum Sesami (U. S. P., 1890). — Oil of Sesamum. (Sesame 
Oil.) 



990 PHARMACOLOGY AND THERAPEUTICS. 

Action of Oil of Sesamum. 
It is emollient and in large doses laxative. 

Therapeutics of Oil of Sesamum. 
Benne oil is used in preparing hair oil. 

WAX. 
CERA FLA VA.— Yellow Wax. 
CERA ALBA.— White Wax. 

Action of Wax. 
Wax has no medicinal qualities. 

Therapeutics of Wax. 
Yellow and white wax are used only as bases for various 
plasters, cerates and ointments. 

PARAFFIN. 

PARAFFINUM.— Paraffin. 

Action of Paraffin. 
None. 

Therapeutics of Paraffin. 
It makes a good basis for ointments used for protecting 
wounds or sores, but as it is absorbed with difficulty, it is not 
suitable for ointments to be applied in cases in which the ab- 
sorption of drugs is desired. In recent years subcutaneous in- 
jections of paraffin have been largely and successfully employed 
for the correction of deformities, especially of the nose. 

SUET. 

SEVUM PR^PARATUM (Sevum, U. S. P., 1890).— Prepared 
Suet. 



BENZIN. 991 

Action of Suet. 
Suet has the action of fats in general. 

Therapeutics of Suet. 
Suet is used chiefly in cerates. 

LYCOPODIUM. 
LYCOPODIUM.— Lycopodium. (Vegetable Sulphur.) 

Action of Lycopodium. 

The plant was formerly regarded as diuretic and antispas- 
modic, but it probably has no physiological action. Lycopodium 
powder has a pronounced property of absorbing oils and oleo- 
resins. 

Therapeutics of Lycopodium. 

It makes an excellent absorbent and protective powder when 
dusted over an excoriated surface, as in the intertrigo of in- 
fants. For this purpose it is often mixed with an equal quantity 
of powdered starch. It is also used as a basis for insufflations. 
As it is powerfully repellent to water, and thus protects hygro- 
scopic substances, it is a good basis for pills, and it is exten- 
sively employed for facilitating the rolling of the pilular mass 
and preventing the adhesion of pills to each other. 

BENZIN. 

BENZINUM.— Petroleum Benzin. 

Preparation. 
Benzinum Purification. — Purified Petroleum Benzin. 

Action of Benzin. 
Large doses give rise to gastro-enteritis, and benzin-poison- 
ing may be induced by its inhalation. 

Therapeutics of Benzin. 
Benzin is used to obtain volatile oils and for depriving pow- 
dered drugs of their fixed oil by percolation, as a substitute 



992 PHARMACOLOGY AND THERAPEUTICS. 

for ether in making oleoresins, and for dissolving fats, resins, 
caoutchouc and some of the alkaloids. It has occasionally been 
employed externally in the treatment of neuralgia, rheumatic 
pains, scabies and prurigo, and internally as a remedy for tape- 
worm. 

CARBON DISULPHIDE. 

CARBONEI DISULPHIDUM.— Carbon Disulphide. (Carbon Bisul- 
phide.) 

Action of Carbon Disulphide. 
Persons exposed to its fumes in the arts are liable to be- 
come emaciated and to be affected with headache, vertigo, 
nervous excitement, incoordination of movement, and de- 
pression of the special senses, with impairment of sensation and 
motility. Even insanity is said to sometimes result. Directly 
inhaled, it excites violent coughing and produces general an- 
aesthesia with marked muscular rigidity. It is a powerful car- 
diac depressant, and even in small doses by the mouth it causes 
severe nausea and vomiting, with a burning sensation in the 
epigastrium, and a weak and rapid action of the heart. 

Therapeutics of Carbon Disulphide. 
Carbon disulphide is used as a solvent. It is the best solvent 
for rubber and similar bodies. It can be freed from its usual 
disgusting odor by repeated rectification. In minute doses it 
is said to relieve gastralgia and the pain of cancer of the 
stomach, as well as nausea and vomiting. 

ACETONE. 

ACETONUM.— Acetone. 

Action of Acetone. 
In small amount it is a normal constituent of the blood 
and urine, and in certain pathological conditions is found in 
larger quantities. It is stated to possess anaesthetic, hypnotic 
and anthelmintic properties. 



talc. 993 

Therapeutics of Acetone. 
It has been given in rheumatism and gout, but its principal 
use is in pharmacy. It is employed in the preparation of chloro- 
form and sulphonal and as a solvent for resins, fats, camphors, 
gun-cotton, etc. 

MASTIC. 
MASTICHE.— Mastic. Dose, 2 gm.; 30 gr. 

Preparation. 
Pilulae Aloes et Mastiches. — Pills of Aloes and Mastic. Dose, 
2 pills. 

Action of Mastic. 
Mastic is a mild stimulant. 

Therapeutics of Mastic. 
It is mostly used as a masticatory, for filling decayed teeth, 
and for cements and varnishes. 

RUBBER. 

ELASTICA.— Rubber. (India-rubber. Caoutchouc.) 

Action of Rubber. 
It is so insoluble that it cannot be absorbed in any form into 
the blood. It therefore has no action on the system. 

Therapeutics of Rubber. 
Rubber is used for making plasters, bougies, pessaries, and 
syringes. 

TALC. 
TALCUM.— Talc. 

Preparation. 
Talcum Purificatum. — Purified Talc. 

Action of Talc. 

None. 
64 



994 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Talc. 

Purified talc makes an excellent filtering basis, and it is em- 
ployed in the manufacture of a large number of official pharma- 
ceutical preparations. 

DRIED CALCIUM SULPHATE. 

CALCII SULPHAS EXSICCATUS.— Dried Calcium Sulphate. 
(Dried Gypsum. Plaster of Paris.) 

Action of Dried Calcium Sulphate. 
Dried calcium sulphate is inert. 

Therapeutics of Dried Calcium Sulphate. 
Dried calcium sulphate is used for making casts of deformi- 
ties and injuries, and for making immovable bandages and ap- 
paratus for injuries and diseases when immobilization is neces- 
sary. 

SODIUM SILICATE. 

Unofficial Preparation. 

Liquor Sodii Silicatis (U. S. P., 1890). — Solution of Sodium 
Silicate. 

Action of Sodium Silicate. 
None. 

Therapeutics of Sodium Silicate. 

It is employed on bandages for making immovable dressings ; 
it is stronger than starch and lighter than plaster of Paris. 

The following drug properly belongs in the Class of General 
Anaesthetics, Division X. 

BROMOFORM. 

RROMOFORMUM.— Bromoform. (Tribromomethane.) Dose, 0.2 
c.c; 3 IT].. 



BROMOFORM. 995 

Action of Bromoform. 
Bromoform, an analogue of chloroform, is anaesthetic and 
antispasmodic, and also has antiseptic properties. When in- 
haled, the narcosis produced by it is shorter than that of ether 
or chloroform. 

Therapeutics of Bromoform. 
It has been employed internally in influenza and spasmodic 
cough, and especially in whooping-cough. In the latter it is 
a remedy of considerable value, but must be employed with 
great caution, as a number of cases of poisoning from its use 
have been reported. As a rule, it is better in this affection 
to depend upon agents attended with less danger than bromo- 
form. On account of its high specific gravity it is likely to 
separate from mixtures unless very carefully compounded. It 
can be administered as follows: Bromoform, i; alcohol. 8; 
glycerin, 48; compound tincture of cardamom, 8. Each fluid 
drachm contains the official dose. 



NDEX. 



In all Latin titles of more than one syllable, the accented syllable is distin- 
guished by the sign ' placed after the corresponding vowel. 



ABSI NTHIUM, 650 
Absorbent cotton, 443 
Aca'cia, 463 
Accelerating centre, drugs 

acting on, 253, 323 
A. C. E. mixture, 896 
Acetanilide, 556 
Acetyl paramidophenol 

salicylate, 731 
Acetone, 992 
Acetone-chloroform, 875 
Acetphenetidin, 564 
Acetyl paramidophenol 
salicylate, 731 

salicylic acid, 721 
Acid, acetic, 331 

acetyl salicylic, 721 

arsenous, 234 

benzoic, 540 

boracic, 83 

boric, 83 

cacodylic, 234, 245 

camphoric, 296 

carbolic, 57 

cetraric, 473 

chromic, 345 

cinnamic, 540 

citric, 331 

chrysophanic, 690, 
691 

di-iodosalicylic, 78, 83 

gallic, 389 

hippuric, 541 

hydriodic, 965 

hydrobromic, 801 

hydrochloric, 330 

hydrocyanic, 573 

hypophosphorous, 915 

iodosalicylic, 74, 83 

lactic, 331 

meconic, 845 



Acid, muriatic, 330 

nitric, 330 

nitrohydrochloric, 330 

nitromuriatic, 330 

oleic, 450 

orthocreosotic, 729 

phenic, 57 

phosphoric, 330 

prussic, 573 

salicylic, 721 

sphacelic, 919 

stearic, 438 

sulphuric, 329 

sulphurous, 106 

tannic, 382 

tartaric, 331 

trichloracetic, 331 
Acids, 329 
Aconine, 310 
Aconite, 305 

preparations of, 305 
Aconitine, 305 
Actions, pharmacological 

and therapeutical, 8 
Actol, 418 
A'deps, 440 

benzoina'tus, 440 

la'nse, 438 

hydro'sus, 438 
Adhesive plaster, 404 
Adjuvant elixir, 461 
Administration of drugs, 

2, 6 
Adonidin, 278 
Adrenalin, 949, 953 
^Esculap, 621 
vE'ther, 901 

ace'ticus, 906 

broma'tus, 907 
JEthy'lis bro'midum, 907 

ca'rbamas, 884 



iEthy'lis chlo'ridum, 770 
Air inhaled, drugs alter- 
ing composition of, 568 
Aix-la-Chapelle, 105 
A'lcohol, 824 

amylic, 839 

ethylic, 824 

tertiary amylic, 877 

trichlor-tertiary butyl, 
875 
Aldehyde, cinnamic, 640 

formic, 49 
A'llium, 652 
Allspice, 638 
Almond, 465 
Aloes, 686 
Aloin, 687 

Alpha-eucaine hydrochlo- 
ride, 765 
Alteratives, 960 
Althse'a, 475 
Alum, 432 

ammonia-ferric, 221 
Alu'mini hydroxidum, 433 

su'lphas, 432 
Aluminum salts, 432 
Alumnol, 435 
Ammonia, solutions of, 
194 

spirit of, 194 
Ammoniac, 670 
Ammonium, 194 

acetate, 206 

benzoate, 540 

bromide, 792 

carbonate, 201 

chloride, 203 

ichthyol sulphonate, 
974 

iodide, 966 

muriate, 203 



997 



INDEX. 



Ammonium nitrate, 207 

salicylate, 721 

valerate, 665 
Amy'gdala ama'ra, 465 

du'lcis, 465 
Amyl colloid, 322 

nitrite, 364 
Amylene hydrate, 877 
A'mylis ni'tris, 364 
Amyloform, 49 
A'mylum, 476 
Anaesthesia, medullary, 

763 
Anaesthetics, general, 740, 
888 

local, 734 

dangers of, 740 
Analgesics, 556, 739 
Anaphrodisiacs, 909 
Anarcotine, 866 
Ane'thum, 649 
Angustura bark, 633 
Anhalonium, 840, 877 
Anhydrotics, 495 
Anhydrogluco-chloral, 876 
Anise, 646 
Anodyne, Hoffmann's, 901 

colloid, 316 
Anodynes, local, 734 
Anthelmintics, 17, 18, 112 
A'nthemis, 651 
Anthracene purgatives, 

694 
Anticholagogues, 626 
Anticholera serum, 941 
Antidiphtheritic serum, 

934 
Antidote, arsenical, 221, 
230 

hydrophobia, 944 
Anti-emetics, 616 
Antifebrin, 556 
Antigalactagogues, 911 
Antihydrotics, 495 
Antikamnia, 561 
Antilithics, 512 
Antimony, preparations 

of, 502 
Antinervine, 561 
Antiparasitics, 18, 122 
Antiperiodics, 18, 128 
Antiplague serum, 940 



Antipneumococcic serum, 

939 
Antipyretics, 553, 556 
Antipyrene, 562 

monochloral, 866 
Antiseptic solution, 84 
Antiseptics, 14, 19 

gastric, 611 

internal, 16, 611, 622 

intestinal, 622, 718 
Antisialogogues, 607, 608 
Antispasmodics, 571, 600 
Antistreptococcic serum, 

938 
Antitetanus serum, 936 
Antitoxin, diphtheria, 934 

tetanus, 936 
Antitoxins and serums, 

933 
Antityphoid serum, 942 
nntivenomous serum, 939 
Antizymotics, 17 
Apenta, 181, 621 
Aphrodisiacs, 908, 911 
Apiol, 931 

Apocodeine, 581, 584 
Apo'cynum, 528 
Apomorphi'nae hydrochlo'- 

ridum, 581 
Apomorphine, 581 
A'qua, 516 

destilla'ta, 516 

hydroge'nii dio'xidi, 
93 
Arbutin, 524 
Argentamine, 418 
Arge'nti cya'nidum, 414 

ni'tras, 414 

o'xidum, 414 
Argonin, 418 
Argyrol, 419 
Aristol, 74, 81 
Armora'cia, 641 
A'rnica, 489 
Aromatic elixir, 654 

fluidextract, 640 

powder, 640 
Arrhenal, 247 
Arsenic, 234 

antidote, 221, 230 

preparations of, 234 

poisoning, 247 



Artificial human milk, 985 

oil of wintergreen, 
729 
Asafetida, 668 
Asafrol, 719 
Ascle'pias, 596 
Ash, prickly, 973 
Asparagin, 475 
Aspi'dium, 112 
Aspidospe'rma, 602 
Aspirin, 721, 729 
Astringents, 327 

intestinal, 623 
Atropine, 803 

and morphine, 864 
Aubergier's syrup, 887 
Aura'ntii a'mari co'rtex, 
654 

du'lcis, co'rtex, 654 
Au'ri et so'dii chlo'ridum, 
971 

BAEL fruit, 636 
Baker's ammonia, 201 
Baking soda, 177 
Balm, 987 
Balsam of fir, 356 

Friar's, 540 
Ba'lsamum Peruvia'num, 
no 

Toluta'num, 566 
Barberry, 632 
Barium salts, 381 
Bark, Angustura, 633 

cassia, 640 

cotton root, 925 

cramp, 932 

Panama, 593 

Peruvian, 128 

prickly ash, 973 

sacred, 692 

sassy, 294 

soap, 593 
Barley, pearl, 459 
Basham's mixture, 221, 

232 
Basilicon ointment, 363 
Bassorin, 465 
Baths, 516 

cold, 516, 517, 519 

hot, 516, 520 

ice-water, 519 



INDEX. 



999 



Baths, indifferent, 516, 520 

tepid, 520 

warm, 516, 520 
Battey's fluid, 963 
Bay rum, 989 
Bearberry, 524 
Be'lse fruc'tus, 636 
Bellado'nna, 802 
Benzaconine, 310 
Benzaldehyde, 465 
Benzin, 991 
Benzoin, 539 
Benzosol, 599 
Benzoyl-guaiacol, 599 
Benzosulphinide, 552 
Berberine, 629 
Be'rberis, 632 
Bergamot, 644 
Beta-eucaine, 765 
Betanaphthol, 718 
Be'tula, oil of, 729 
Bile, drugs acting on, 624 
Bismuth, 673 
Bitter apple, 705 
Bitters, 610, 627 
Bittersweet, 977 
Bladder, drugs acting on, 

515 
Bladderwrack, 964 
Blackberry, 400 

cohosh, 929 

draught, 694 

drop, 843 

haw, 932 

manganese oxide, 930 

mustard, 478 

pepper, 656 

snake root, 929 

wash, 21 
Blaud's pills, 221 
Bleaching powder, 53 
Bliss' cvire, 819 
Blisters, 534 
Blood, drugs acting on, 

148 
Bloodroot, 596 
Blue cohosh, 928 

flag, 512 

Lick Springs, 105 

mass, 19 

methylene, 887 

ointment, 19 



Blue pill, 19 

stone, 428 

vitriol, 428 
Boneset, 508 
Borax, 84 
Boro-glycerin, glycerite 

of, 83 
Bougies, 4 

Bourboule water, 231, 245 
Brain, drugs acting on, 
737, 802 

extract, 958 
Brandy, 824 
Bromal, 876 
Bromides, 792, 793 

comparative action of 
the, 796 
Bromine, 793 
Bromism, 797 
Bromoform, 994 
Bro'mum, 792 
Bronchial secretion, drugs 
affecting, 570, 581 

vessels, drugs acting 
on, 571 

spasm, drugs relax- 
ing, 57i 
Broom, 522 
Brown mixture, 461 
Brucine, 777, 780 
Bryo'nia, 710 
Bucco, 523 
Buchu, 523 
Buckthorn, 696 
Burdock, 997 
Burgundy pitch, 362 
Burnett's fluid, 426 
Burton's line, 406 
Butternut, 692 
Butter of cacao, 444 

of zinc, 422 
Butyl-chloral hydrate, 873 
Byne, 456 

CACAO butter, 444 
Cacodylic acid, 234, 
245 
Ca'ctus, 323 
Cade, oil of, 361 
Caffeine, 282 
Cajuput, oil of, 482 
Calabar bean, 783 



Ca'lamus, 631 
Calcium, 214 

beta-naphthol alpha- 
monosulphonate,7i9 

bromide, 792 

carbonate, precipitat- 
ed, 214 

chloride, 219 

glycerophosphate, 917 

hydroxide, 216 

hypophosphite, 915 

lacto-phosphate, syrup 
of, 218 

oxide, 215 

phosphate, 218 

sulphate, dried, 994 

sulphide, crude, 103 
Cale'ndula, 978 
Calomel, 19 
Calu'mba, 627 
Calx, 215 

chlorina'ta, 53 

sulphura'ta, 103 
Cambo'gia, 704 
Camphor, 296 

preparations of, 296 

salol, 730 
Canada turpentine, 356 
Canadian hemp, 528 

moonseed, 979 
Cane'lla, 635 
Ca'nnabis i'ndica, 840 
Canquoin's paste, 425 
Cantha'rides, 531 
Caoutchouc, 993 
Ca'psicum, 658 
Caraway, 648 
Carbamate, ethyl, 884 
Ca'rbo, anima'lis, 95 

li'gni, 95 
Carbolic acid, 57 
Carbon disulphide, 992 
Cardamom, 661 
Cardiac mechanism, drugs 

acting on, 249 
Carlsbad water, 181 
Carminative tincture, 662 
Carminatives, 613 
Carolina pink, 121 
Carron oil, 216, 446 
Ca'rum, 648 
Caryo'phyllus, 636 



ooo 



INDEX. 



Casca'ra sagra'da, 692 
Cascari'lla, 632 
Ca'ssia bark, 640 

fi'stula, 682 

purging, 682 
Casta'nea, 604 
Castile soap, white, 451 
Castor oil, 682 
Catapla'sma kaoli'ni, 437 
Ca'techu, 393 
Cathartic pills, compound, 
19 

vegetable, 705 
Cathartics, 620 
Caulophy'llum, 928 
Caustic, lunar, 414 

mitigated, 414 

potash, 152 

soda, 174 

Vienna, 152 
Caustics, 326 
Celandine, 699 
Ce'ra a'lba, 990 

fla'va, 990 
Cerate, 440 
Cerates, 5 

Cerebral depressants, 739, 
843 

excitants, 738 

stimulants, 738 
Ce'reus grandiflo'rus, 323 
Ce'rium oxalate, 679 
Ceta'ceum, 440 
Cetra'ria, 473 
Chalk, preparations of, 214 
Chamomile, 651 

German, 652 
Champagne, 836 
Charcoal, 95 
Chaulmoogra oil, 441 
Chelido'nium, 699 
Chemical constitution and 

physiological action, 9 
Chenopo'dium, 122 
Cherry laurel, 580 

wild, 579 
Chestnut, 604 
Cheyne-Stokes breathing, 
drugs which produce, 

573 
Chima'phila, 978 
Chira'ta, 633 



Chire'tta, 633 
Chloral, 866 
Chloralamide, 874 
Chloralformamide, 874 
Chlora'lum hydra'tum, 

866 
Chloralose, 876 
Chloretone, 875 
Chlorinated lime, 53 

soda, solution of, 53 
Chlorine, 53 

compound solution 
of, 53 

water, 53 
Chlorobrom, 975 
Chlorodyne, 888 
Chloroform, 888 

Commission, British 
Medical Associa- 
tion, 900 

Hyderabad, 891 
Chlorofo'rmum bellado'n- 

nae, 810 
Chlorophenol, 57, 67 
Chlo'rum, 53 
Cholagogues, 625 
Cholera serum and inocu- 
lation, 941 
Cho'ndrus, 474 
Chromium trioxide, 345 
Chrysophan, 695 
Chrysophanic acid, 691 
Chrysarobin, 122, 690, 695 
Churchill's tincture, 963 
Cigarettes, 4 
Ciliary muscle, drugs 

acting on, 743 
Cimici'fuga, 929 
Cincho'na, 128 

relative action of al- 
kaloids of, 139 

preparations of, 128 

ru'bra, 128 
Cinchonism, 138 
Cineol, 483 
Cinnabar, 21 
Cinnaldehy'dum, 640 
Cinnamic aldehyde, 640 
Cinnamon, 640 
Citrine ointment, 20 
Citric acid, 331 
Citrullin, 707, 708 



Clarendon, 215 

Claret, 824 

Clark's powder, 144 

Classification of drugs, 14 

Clemens' bromide solu- 
tion, 224 

Cloves, 636 

Clutterbuck's elaterium, 
709 

Clysters, 4 

Co'ca, 759 

Cocaine, 759 

Cocainization, spinal, 763 

Cocamania, 764 

Co'ccus, 988 

Cochineal, 988 

Cocilla'fia, 584 

Codeine, 865 

Cod liver oil, 950 

Coffee, 283, 291 

Cohosh, blue, 928 
black, 929 

Co'la, 293 

Colchicine, 716 

Co'lchicum, 713 

Colchisal, 713, 716 

Collodion, 443 

Colloid, amyl, 305 
mercury, 21 

Colloidal silver, 419, 422 

Colocynth, 705 

Colocynthin, 706, 708 

Colophony, 363 

Columbian spring, Sara- 
toga, 231 

Columbo, 627 

Condal, 181 

Condy's fluid, 92 

Coniine, 746 

Coni'um, 74s 

Contrexe'ville, 215 

Convalla'ria, 281 

Copa'iba, 545 

Copaiva, 545 

Copper sulphate, 428 

Coriander, 647 

Corn-silk, 529 

Cornutine, 919 

Corrosive sublimate, T9 

Corson's paint, 711 

Coster's paste, 963 

Coto, 402 



INDEX. 



IOOI 



Cotton, 443 

root bark, 925 
Couch grass, 538 
Counter-irritants, 326 
Court plaster, 439 
Cramp bark, 932 
Cream of tartar, 165 
Crede's ointment, 419 
Creolin, 72 
Creosotal, 597, 598 
Creosote, 597 
Cre'sol, 57, 67 
Cre'ta praepara'ta, 214 
Cro'cus, 988 
Crotin, 711 

Croton chloral hydrate, 
873 

oil, 710 
Cubeb, 548 
Cu'ca, 759 

Cucumber, bitter, 705 
Culver's root, 701 
Cumulative action, 7 
Cu'pri su'lphas, 428 
Curare, 744 
Curd soap, 451, 455 
Cuspa'ria, 533 
Cusso, 1 1 5 
Cypripe'dium, 667 



DAMIA'NA, 918 
Dandelion, 635 
Deco'ctum ad icte'ricos, 

699 
Definitions, 2 
Deliriants, 738 
Delphinine, 125, 126 
Demulcents, 328 
Deodorants, 17 
Depressants, cerebral, 739, 

843 
Dermatol, 673 
Dextroform, 49 
Diabetin, 461 
Diachylon ointment, 404 

plaster, 404 
Dialyzed iron, 223 
Diaphoretics, 494, 496 
Diastase, 456 
Diethylsulphonedimethyl- 

methane, 878 



Diethylsulphonmethyl- 
ethyl-methane, 880 

Digestants, animal, 662 

Digestive apparatus, drugs 
acting on, 606 

Digitalin, 254 

Digita'lis, 253 

Digitoxin, 254 

Di-iodosalicylic acid, 74, 
83 

Di-isobutylorthocresol 
iodide, 74 

Dill, 649 

Dimethylethylcarbinol, 
877 

Dinner pill, 686 

Dionine, 844, 860 

Diphtheria antitoxin, 934 

Direct action, 8 

Disinfectants, 14 

Dispermine, 530 

Dissolution, law of, 737 

Diuretics, 509, 516 

Diuretin, 528 

Dock, yellow, 401. 

Dog button, 772 

Donovan's solution, 234 

Doses, 5 

for children, 5 

Dover's powder, 843 

Droitwich water, 188 

Drop chalk, 214 

Drugs, modes of adminis- 
tration of, 2 

Duboisine, 818 

Dulcama'ra, 977 

Dulcin, 552 

Durand's remedy, 354 

Dusart's syrup, 233 



EAR, drugs acting on, 
744 
Easton's pill, 232 

syrup, 232 
Eau de goudron, 360 
Ecbolics, 909, 919 
Effervescing powder, com- 
pound, 143 
Egg, 441 
Ela'stica, 993 
Elaterin, 708 



Elaterium, 708 
Elder, 649 
Elecampane, 600 
Electrozone, 54, 56 
Elemi, 493 
Eli'xir, adjuvant, 461 

aromatic, 654 

fe'rri, quini'nae et 
strychni'nse phos- 
pha'tum, 222 

pho'sphori, 912 
Elm, slippery, 462 
Emetics, 614 
Emetine, 586 
Emmenagogues, 910, 930 
Emollients, 328 
Empirical therapeutics, 1 
Ene'mata, 4, 621 
Enteroclysis, 3 
Epinephrin, 952 
Epson salt, 209 
Ergot, 919 

oil of, 924 
Ergotin, 919 
Ergotism, 921 
Erigeron, oil of, 357 
Eriodi'ctyon, 603 
Erythrophlceine, 2q.\ 
Erythro'phloeum, 294 
Erythrol tetranitrate, 379 
Erythro'xylon, 759 
Escharotics, 326 
Eserine, 783 
Essence of nutmeg, 639 

of peppermint, 644 

of spearmint, 646 
Ether, 901 

acetic, 906 

chloric, 883 

hydrobromic, 907 

nitrous, spirit of, 378 

sulphuric, 901 
Ethyl acetate, 906 

alcohol, 824 

bromide, 907 

carbamate, 884 

chloride, 770 

oxide, 901 

urethane, 884 
Ethylirtes chloral-ure- 

thane, 866 
Eucaine, 765 



1002 



INDEX. 



Eucalyptol, 483 
Eucal'yptus, 483 

gum, 401 
Eudermol, 749, 752 
Eudoxin, 678 
Eugenol, 636, 638 
Eunatrol, 447 
Euonymin, 698 
Euo'nymus, 697 
Eupato'rium, 508 
Europhen, 74, 82 
Exalgin, 565 
Excretion, rate of, 7 
Expectorants, 572, 581 
Extracts, organic, 945 
Eye, drugs acting on, 742 

FABIA'NA, 528 
Family pill, 503 
Eel bo'vis, 696 
Fennel, 648 
Ferratin, 223, 233 
Ferric hypophosphite, 915 
Fe'rrum, 220 
Fi'cus, 581 
Fig, 681 
Fir wood oil, 356 

balsam of, 356 
Flag, sweet, 631 
Flaxseed, 445 
Fleabane, oil of, 357 
Flitwick water, 231 
Flowers of sulphur, 98 
Fceni'culum, 648 
Formaldehyde, 15, 49 
Formalin, 49 
Formol, 49 
Fowler's solution, 234 
Foxglove, 253 
Fra'ngula, 696 
Frankincense, 364 
Franz Joseph, 181 
Friedrichshall, 181, 621 
Friar's balsam, 540 
Fusel oil, 839 

GALACTAGOGUES, 
9.. 
Galba'num, 671 
Ga'lla, 382 

Gallacetophenone, 389 
Gambir, 393 



Gamboge, 704 
Gargari'smata, 4 
Gargles, 4 
Garlic, 652 

Gastric antiseptics, 611 
juice, action of drugs 

on, 609 
sedatives, 613, 673 
Gastro-intestinal irritants, 

612 
Gaulthe'ria, 729 
Gelatin, 475 » 

Gelsemine, 790 
Gelse'mium, 788 
Generation, drugs acting 

on organs of, 908 
Gentian, 630 
Gera'nium, 399 
Gin, 527 
Ginger, 660 

Gla'ndulae suprarena'les 
si'ccae, 380, 949 
thyroide'ae si'ccae, 946 
Glauber's salt, 179 
Glonoin, spirit of, 374 
Gluside, 552 
Glutoform, 49 
Glutol, 49, 53 
Glycerin, 467 
Glycerites, 467 
Glycerol, 608 
Glycerophosphates, 917 
Glyceryl trinitrate, 374 
Glycoformalin, 49 
Glycogelatin, 476 
Glycogenic function, 626 
Glyconin, 441 
Glycosuria, 626 
Glycyrrhi'za, 461 
Glycyrrhizin, ammoniated, 

461 
Gold and sodium chloride, 

971 
Gold seal, 925 
Gossy'pii co'rtex, 925 
Goulard's cerate, 404 

extract, 404 
Gourd, bitter, 705 
Grana'tum, 115 
Gray powder, 19 
Green mercurous iodide, 

20 



Green, Paris, 247 

Scheele's, 247 

Schweinfurth's, 247 

soap, 451 

solution, 726 
Grinde'lia, 600 
Guaiac, 972 
Guaiacol, 599 
Guara'na, 292 
Gum arabic, 463 

Benjamin, 539 

camphor, 296 

guaiac, 972 

red, 401 
Gun cotton, 443 
Guy's pill, 280 
(jypsum, dried, 994 

H.EMATINICS, 150 
indirect, 150 
Hacmato'xylon, 396 
Haemostatics, 328 
Hamame'lis, 397 
Habit, 5 

Harrogate water, 105 
Hartshorn, 201 
Haschisch, 840 
Heart, drugs acting on, 

250, 253 
Heat as an antiseptic, 15 

bodily, drugs acting 
on, 553 
increasing, 555 
Hedeo'ma, 650 
Helenin, 600 
Hemide'smus, 975 
Hemlock, spotted, 745 
Hemp, Indian, 840 

Canadian, 528 
Henbane, 819 
Hepatic stimulants, 625 
Heroine, 845, 860 
Hexamethylenamine, 538 
Himrod's cure, 819 
Hive syrup, 279, 502 
Hoffman's anodyne, 901 
Holocaine, 767 
Homatropine hydrobrom- 

ide, 817 
Honey, 680 
Hops, 885 
Horehound, 508 



INDEX. 



IOOl 



Horseradish, 641 

Hu'mulus, 885 

Hunyadi Janos, 181, 621 

Hyderabad commission, 
891 

Hydragogues, 620 

Hydra'rgyri cklo'ridum 
corrosi'vum, 19 
chlo'ridum mi'te, 19 
cya'nidum, 20 
empla'strum, 19 
io'didum fla'vum, 20 
io'didum ru'brum, 20 
o'xidum fla'vum, 20 
o'xidum ru'brum, 20 
subsu'lphas fla'vus, 21 

Hydrargyrol, 21 

Hydra'rgyrum, 19 

ammonia'tum, 19 
cum cre'ta, 19 

Hydrastine, 925 

Hydra'stis, 925 

Hydrated chloral, 866 

Hydriodic acid, 965 

Hydrobromic acid, 801 
ether, 907 

Hydrochloric acid, 330 
ether, 770 

Hydrocyanic acid, 573 

Hydrogen dioxide, solu- 
tion of, 93 

Hydronaphthol, 718, 719 

Hydrophobia antidote, 944 

Hydroxide, ferric, 221 
potassium, 152 
sodium, 174 

Hyoscine, 820 

Hyoscyamine, 820 

Hyoscy'amus, 819 

Hypnal, 866, 871 

Hypnone, 866, 872 

Hypnotics, 739 

Hypodermic injections, 2 

Hypodermoclysis, 3 

Hypophosphites, 916 

Hypophosphorus acid, 915 

TCE BAGS, 519 
A Ice-water baths, 519 
Ichthyoco'lla, 439 
Ichthyol, 974 
Idiosyncrasy, 5 



Uli'cium, 646 
Imperial drink, 166 
Index, 997 
India rubber, 993 
Indian hemp, 840 

tobacco, 754 

sarsaparilla, 975 
Indirect action, 8 
Infusions, intravenous, 2 
Inhalations, 4 
Injections, 2, 4 
Insufflations, 4 
Intestinal antiseptics, 622 
718 

astringents, 623 
Intestines, drugs acting 

on, 617, 680 
Intra-ocular tension, 744 

venous injection, 2 
I'nula, 600 
Inunction, 4 
Iodantipyrine, 562 
Iodides, 966 
Iodine, 74, 960 
Iodism, 967 
Iodoform, 74 
Iodol, 74, 81 
Iodopyrine, 562 
Iodosalicylic acid, 74, 83 
Iodo-tannin, 382 
Iodothyrin, 946, 949 
Ions, theory of, 10 
Ipecac, 585 
Ipecacua'nha, 585 
Iridin, 699 
Iris, 698 
Iron, 220 

preparations of, 220, 
232 

Quevenne's, 220 

wood, 602 
Irritants, 325 

gastro-intestinal, 612 
Isinglass, 439 
Itrol, 418 
Ivy, poison, 979 
Izal, 72 

TABORANDI, 496 
J Jaborine, 500 
Jalap, 703 
Jalapin, 702, 703 



James' powder, 503 
Jamestown weed, 818 
Jarisch's ointment, 392 
Jasmine, yellow, 788 
Jervine, 316 
Jeyes' disinfectant, 74 
Ju'glans, 692 
Juniper, 526 

KAMA'LA, 114 
Kaolin, 437 
Kemp-Gardner method, 

899 
Kermes mineral, 503 
Ki'no, 395 
Kissingen, 181 
Kombe poison, 273 
Kousso, 1 1 5 
Krame'ria, 394 
Kumyss, 986 

LABARRAQUE'S solu- 
tion, 53 
La Bourboule, 231, 245 
Lac, 984 

su'lphuris, 98 
Lactic acid, 331 
Lactophenine, 565 
Lactose, 477 
Lactuca'rium, 886 
Lactylparaphenetidine, 56 5 
Lady Webster's pill, 686 
Ladies' slipper, 667 
Lanolin, 438 
La'pis divi'nus, 429 
La'ppa, 977 
Lard, 440 
Largin, 419 
Laudanum, 843 
Lauroce'rasus, 580 
Lavender, 643 
Laxative tincture, 693 

pills, compound, 686 
Laxatives, 618, 680 
Lead poisoning, 411 

salts, 403 
Lemon, 655 
Lenigallol, 389, 392 
Lepta'ndra, 701 
Lettuce, 886 
Levant wormseed, 118 
Levico water, 231, 245 



ioo4 



INDEX. 



Levulose, 461 
Li'gnum vi'tae, 972 
Lily of the valley, 281 
Lime, 216 

chlorinated, 53 

preparations of, 216 

sulphurated, 103 
Limo'nis co'rtex, 655 

su'ccus, 655 
Linseed, 445 
Li'num, 445 
Li'quor antise'pticus, 84 

chlo'ri compo'situs, 53 

pi'cis carbo'nis, 359 

so'dae chlorina'tae, 53 
Liquorice, 461 
Lister's ointment, 88 
Litharge, 403 
Lithium, 207 

benzoate, 657 

bromide, 792 

carbonate, 207 

citrate, 207 

glycerophosphate, 917 

salicylate, 721 

vanadate, 207 
Lithontriptics, 513 
Liver, drugs acting on, 

624, 626 
Llangammarch wells, 382 
Lob'elia, 754 
Lobeline, 755 
Local action, 8 

anodynes, 734 

anaesthetics, 734 
Logwood, 396 
London paste, 216 
Losophan, 74, 83 
Lo'tio fla'va, 21 

ni'gra, 21 

ru'bra, 426 
spi'ritus, 835 
Lugol's solution, 960 
Lunar caustic, 414 
Lupulin, 885 
Lycetol, 530 
Lycopo'dium, 991 
Lysidine, 530 
Lysol, 71 



M 



AAS' PROCESS, 899 
Mace, 639 



Magnesia, 210 
Magnesium, 209 

glycerophosphate, 917 
salts, 210 
Male fern, 112 
Malt, 456 
Maltose, 457 
Mammary extract, 956 
Mandrake, 699 
Manganese dioxide, 930 

hypophosphite, 915 

sulphate, 930 
Ma'nna, 681 
Marienbad, 181 
Marigold, 978 
Marrow, red bone, 959 
Marru'bium, 508 
Marsden's paste, 240 
Marsh's test, 249 
luarshmallow, 475 
Mass, blue, 19 

of copaiba, 545 

of ferrous carbonate, 
221 

Vallet's, 221 
Mastic, 993 
Ma'tico, 551 
Matrica'ria, 652 
May apple, 699 
McDade's formula, 974 
Meat extract, 984 
Medullary anaesthe'sia, 763 
Mel, 680 
Meli'ssa, 987 
Menispe'rmum, 979 
Mental influences, 6 
Me'ntha piperi'ta, 644 

vi'ridis, 646 
Menthol, 756 
Mercuric ammonium chlo- 
ride, 20 

chloride, corrosive, 
15, 1 

cyanide, 20 

iodide, red, 20 

nitrate, 20 

oxide, red, 20 
yellow, 20 

subsulphate, yellow, 
21 

sulphide, 21 
Mercurol, 21 



Mercuro-zinc cyanide, 41 
Mercurous chloride, mild, 
19 
iodide, yellow, 20 
tannate, 21 
Mercury, 1 9 

ammoniated, 19 
antiparasitic action 

of, 32 
colloid, 21 
mass of, 19 
modes of administra- 
' tion of, 42 
oleate of, 20 
preparations of, 19 
in syphilis, 39 
vegetable, 700 
with chalk, 19 
Metabolism, drugs acting 

on, 960 
Methyl acetanilide, 565 
chloride, 770 
morphine, 865 
salicylate, 729 
Methylene blue, 887 
Methylthionine hydrochlo- 
ride, 887 
Mezere'um, 492 
Miaouli, oil of, 482 
Michel's paste, 332 
Milk, 984 

artificial human, 985 
drugs acting on, 911 
drugs excreted by, 

911 
peptonized, 985 
sugar of, 477 
Mindererus, spirit of, 206 
Modes of administration 

of drugs, 2 
Monochlor-ethane, 770 

methane, 770 
Monsel's solution, 220, 

228 
Moonseed, Canadian, 979 
Morphine, 844 

benzylic ester hydro- 
chlorate, 845 
diacetic ester, 845 
methyl, 865 
monoethyl ester hy- 
drochlorate, 845 



INDEX. 



IOO5 



Morton's fluid, 964 

Mo'schus, 304 

Moss, Iceland, 473 
Irish, 474 

Motor nerves, drugs act- 
ing on, 732 

Mountain balm, 603 

Muriatic acid, 330 

Muscarine, 791 

Muscles, drugs acting on, 
732 

Muscular and nervous 
systems, drugs acting 
on, 732 

Musk, 304 

Musk root, 642 

Mustard, 478 

Mutton suet, 990 

Mydriatics, 743 

Myotics, 743 

My'rcia, 989 

Myri'stica, 639 

Myrrh, 671 

N\NTWICH water, 188 
Naphthalene, 720 
Naphthol, camphorated, 

719 
Naphtol, 718 
Narcotics, 739 
Narcotine, 866 
Nasal douches, 4 
Ne'bulae, 4 
Neroli, oil of, 654 
Nerves, drugs acting on, 

732, 733 
Nervous system, drugs 

acting on, 732 
Neuritis, drugs causing, 

735 
Nicotine, 749 

salicylate, 752 
Night blooming cereus, 

323 
Nightshade, deadly, 802 
Nitre, sweet spirit of, 378 
Nitric acid, 330 
Nitrites, 364 
Nitroglycerin, 374 
Nitrohydrochloric acid, 

330 
Nitromuriatic acid, 330 



Nitrous ether, spirit of, 

378 
Norwood's tincture, 320 
Nutgall, 382 
Nutmeg, 639 
Nutrient serum, 943 
Nux vo'mica, 772 

OAK, poison, 660 
white, 382 
Oil of allspice, 638 

almond expressed,466 
American wormseed, 

122 
anise, 646 
bay, 989 
bergamot, 644 
betula, 729 
bitter almond, 465 
cade, 361 
cajuput, 482 
caraway, 648 
Carron, 216, 446 
cassia, 640 
castor, 682 
chamomile, 651 
chaulmoogra, 441 
cinnamon, 640 
cloves, 636 
cod liver, 980 
copaiba, 545 
coriander, 647 
cotton seed, 443 
croton, 710 
cubeb, 548 
dill, 649 
erigeron, 357 
ergot, 924 
ethereal, 901 
eucalyptus, 483 
fennel, 648 
firwood, 356 
flaxseed, 445 
fleabane, 357 
fusel, 839 
gaultheria, 729 
hedeoma, 650 
juniper, 526 
lard, 440 
lavender, 643 

flowers, 644 
lemon, 655 



Oil, linseed, 445 

miaouli, 482 

mustard, volatile, 478 

myrcia, 989 

neroli, 654 

nutmeg, 639 

olive, 447 

orange flowers, 654 
peel, 654 

pennyroyal, 650 

peppermint, 644 

phosphorated, 912 

pimenta, 638 

pine, 356 

rose, 653 

rosemary, 489 

rue, 929 

santal, 550 

sassafras, 976 

savin, 928 

sesame, 989 

spearmint, 646 

star-anise, 647 

sweet, 605 

sweet birch, 729 

tar, 358 

theobroma, 444 

thyme, 551 

turpentine, 348 

valerian, 666 

vitriol, 329 

wintergreen, 729 
Oleic acid, 450 
Olive oil, 447 
Opium and its prepara- 
tions, 843 

and morphine, differ- 
ences in action, 851 

poisoning, diagnosis 
of, 861 
Opodeldoc, 451 
Orange, 654 
Organic extracts, 945 
Organisms infecting the 
body, diugs acting on 
14 
Orthoform, 768 
Osmosis, 13 
Ouabain, 771 
Ovarian extract, 956 
Oxgall, 696 
Oxygen, 604 



ioo6 



INDEX. 



Oxymel, 680 
Oxytocics, 909 

PACK, cold, 518 
hot, 526 
Painter's palsy, 407 
Pancreatin, 664 
Papaverine, 866 
Paracotoin, 402 
Paraffin, 990 
Paraform, 49, 53 
Paraldehyde, 882 
Paramorphine, 866 
Parasiticides, 18, 122 
Paregoric, 844 
Pare'ira, 527 
Paris green, 247 
Parish's food, 233 
Parsley, 931 
Parotid extract, 959 
Paste, Coster's, 963 
London, 216 
Marsden's, 240 
Ricord's, 332 
Vienna, 216 
Pearson's solution, 243 
Pelletieri'nse ta'nnas, 116 
Pellitory, 657 
Pellotine, 877 
Pennyroyal, 650 
Pental, 908 
Pe'po, 117 
Pepper, 656 

cayenne, 658 
Guinea, 658 
Peppermint, 644 
Pepsin, 662 
Peronine, 845, 861 
Peru, balsam of, no 
Peruvian bark, 128 
Pessaries, 4 
Petrola'tum, 442 
Petroleum benzin, 991 
Pharmaco-dynamics, 1 
Pharmacognosy, defini- 
tion, 1 
Pharmacological actions, 

8 
Pharmacology, definition, 

1 
Phenacetine, 564 
Phenazo'num, 562 



Phenocoll hydrochloride, 

566 
Phenol, 57 
Pheno-salyl, 57, 67 
Phenosulphonate, sodium, 
70 
zinc, 70 
Phenylacetamide, 556 
dimethylpyrazolone, 

562 
methyl-acetone, 866 
salicylate, 730 
Phosphorated oil, 912 
Phosphoric acid, 330 
Pho'sphorus, 91 1 

poisoning, 913 
Physiological action, 8 
Physosti'gma, 783 
Physotigmine, 783 
Phytolacca, 717 
Pichi, 528 
Picrotoxin, 126 
Pigme'nta, 4 
Pills, Blaud's, 221 
blue, 19 

cathartic, compound, 
19 
vegetable, 705 
chalybeate, 221 
ferruginous, 221 
Lady Webster, 686 
laxative, compound, 

686 
of podophyllum, bel- 
ladonna and capsi- 
cum, 699 
Trousseau's, 428 
Piloca'rpus, 496 
Pi'lula plumbi cum opio, 
856 
tri'um phospha'tum, 
232 
Pime'nta, 638 
Pink root, 121 
Pinol, 356 
Pi'per, 656 
Piperazine, 530 
Piperine, 656 
Pipsi'ssewa, 978 
Pitch, Burgundy, 362 
Pituitary extract, 955 
Pix H'quida, 357 



Pixol, 360 

Plague serum and inocu- 
lation, 940 
Plasma, drugs acting on, 

148, 152 
Plaster of Paris, 159 
Plasters, 5 

Piatt's chlorides, 426 
Pleurisy root, 496 
Plu'mbi ace'tas, 404 
ca'rbonas, 404 
io'didum, 404 
ni'tras, 404 
o'xidum, 403 
Plummer's pills, 503 
Pneumogastric, drugs act- 
ing on, 252 
Podophyllum, 699 
Poison hemlock, 745 
ivy, 979 
nut, 772 
oak, 979 
Poisons, 2 
Poke berry, 717 

root, 717 
Pomegranate, 115 
Pond's extract, 398 
Poppy capsules, 853 
Posology, 5 
Potash, caustic, 152 

yellow prussiate of, 
573 
Pota'ssa, 152 

sulphura'ta, 103 
Pota'ssium, 152 
acetate, 161 
alum, 432 
and sodium tartrate, 

180 
arsenite, solution of, 

234 
bicarbonate, 159 
bichromate, 345 
bitartrate, 165 
bromide, 792 
cantharidinate, 531 
carbonate, 1 59 
chlorate, 169 
citrate, 161 
cyanide, 573 
dichromate, 345, 347 
ferrocyanide, 573 



INDEX. 



007 



Pota'ssium glycerophos- 
phate, 917 
hydroxide, 152 
hypophosphite, 915 
iodide, 965 
nitrate, 167 
oleate, 453 
permanganate, 89 
salts, action of, 152 
sulphate, 165 
tartrate, acid, 165 
Powder, aromatic, 640 

compound effervesc- 
ing, 180 
Dover's, 843 
gray, 19 
James', 503 
Seidlitz, 180 
Precipitate, red, 20 

white, 19 
Preparations, 7 
Primary action, 8 
Proof spirit, 824 
Protargol, 418 
Prune, 681 

Pru'nus Virginia'na, 579 
Prussiate of potash, yel- 
low, 573 
Prussic acid, 573 
Pullna, 181, 621 
Pulsatilla, 603 
Pu'lvis acetanili'di com- 
po'situs, 556 
aroma'ticus, 640 
cre'tse compo'situs, 

214 
effeve'scens compo'si- 
tus, 180 
glycyrrhi'zse, com- 

po'situs, 461 
ipecacua'nhae et o'pii, 

843 
jala'pae compo'situs, 

703 
morphi'nae compo'si- 
tus, 844 
rhe'i compo'situs, 639 
salicy'licus cum 

ta'lco, T2"j 
Pumpkin seed, 117 
Pupil, drugs acting on, 
742 



Purgatives, 618, 680 
anthracene, 694 
drastic, 620 
saline, 620 
simple, 619, 686 

Pustulants, 326 

Pyre'thrum, 657 

Pyridine, 749, 753 

Pyrogallol, 389 

Pyroxylin, 443 

QUAIN'S pill, 692 
Qua'ssia, 630 

Quebracho, 602 

Queen s root, 977 

Que'rcus, 382 

Quevenne's iron, 220 

Quicksilver, 19 

Quilla'ja, 593 

Quinine, 128 

preparations of, 128 
specific action of, 141 

RAISINS, 455 
Raspberry, 987 
Red bone marrow, 959 

corpuscles, drugs act- 
ing on, 149, 220 

cinchona, 128 

gum, 401 

precipitate, 20 

saunders, 989 

wine, 824 
Refrigerants, 609 
Reinsch's test, 249 
Remote action, 8 
Resi'na, 363 
Resorbin, 467 
Resorcinol, 721 
Respiration, drugs acting 

on, 567 
Respiratory centre, drugs 
acting on, 569, 573 

depressants, 569 

disinfectants, 568 

stimulants, 569 
Retinol, 362 

Rha'mnus purshia'na, 692 
Rhatany, 394 
Rhe'um, 689 
Rhubarb, 689 
Rhus gla'bra, 399 



Rhus toxicode'ndron, 979 
Richfield Springs, 102, 413 
Ricin, 683 
Ricord's paste, 332 
Rise of temperature, drugs 

causing, 555 
Risus sardonicus, 781 
Rochelle salt, 180 
Rose, 653 

Rosemary, oil of, 439 
Rosin, 363 
Rubber, 993 
Rubefacients, 325 
Rubidium and ammonium 
bromide, 792 
iodide, 966 
Rubinat, 621 

Condal, 181, 621 
Ru'bus, 400 

idae'us, 987 
Rue, 929 

Rush's thunderbolt, 704 
Ru'mex, 401 
Rye, ergot of, 919 

SA'BAL, 526 
Sabi'na, 928 
Saccharin, 552 
Sa'ccharum, 459 

la'ctis, 477 
Saffron, 988 
Safrol, 976 
Sage, 652 
Sal alembroth, 41 

ammoniac, 203 

volatile, 201 
Salicin, 721 
Salicylism, 725 
Saligen, "J22 
Saline purgatives, 620 
Salipyrine, 562 
Salivary glands, drugs 

acting on, 607 
Salol, 730 

camphor, 730 
Salophen, 731 
Salt action, 183 

Epsom, 209 

Glauber's, 179 

Rochelle, 180 

of tartar, 159 
Sa'liva, 652 



:oo8 



INDEX. 



Sambu'cus, 649 

Sandalwood, oil of, 550 

Sanguina'ria, 596 

Sanitas, 352 

Santal, oil of, 550 

Sa'ntalum ru'brum, 989 

Santo'nica, 118 

Santonin, 118 

Sa'po, 451 

anima'lis, 455 
mo'llis, 453 

Sarsapari'lla, 975 
Indian, 975 

Sa'ssafras, 976 

Sassy bark, 294 

Saunders, red, 989 

Savin, 928 

Saw palmetto, 526 

Scammony, 702 

Scheele's green, 247 

Schleich's infiltration 
method, 762 

Schweinfurth's green, 247 

Sci'lla, 279 

Scopa'rius, 522 

Scopo'la, 822 

Scopolamine, 820, 822 

Scott's ointment, 35 

Scutellaria, 979 

Secondary action, 8 

Sedatives, gastric, 613, 673 

Seidlitz powder, 180 

Se'nega, 591 

Senegin, 591 

Se'nna, 694 

Sensory nerves, drugs act- 
ing on, 733, 734, 756 

Serous cavities, injections 
into, 4 

Serpenta'ria, 634 

Serum, anticholera, 941 
antidiphtheric, 934 
antiplague, 940 
antipneumococcic, 939 
antistreptococcic, 938 
antitetanus, 936 
antityphoid, 942 
antivenomous, 939 
nutrient, 943 

Serums, 933 

Sesame, 989 

Se'vum prsepara'tum, 990 



Sialogogues, 607 
Silver salts, 414 
Si'napis a'lba, 478 

ni'gra, 478 
Skin, drugs acting on, 493 
Skullcap, 979 
Smedley's paste, 659 
Snakeroot, black, 929 

Virginia, 634 
Soap, 451 
Soda, 174 

baking, 177 

caustic, 174 

tartarated, 180 
Sodium, 174 

acetate, 191 

arsenate, 234 

benzoate, 540 

bicarbonate, 177 

borate", 84 

bromide, 792 

cacodylate, 234, 245 

carbonate, 176 
dried, 176 
monohydrated, 
176 

chlorate, 191 

chloride, 144 

citrate, 192 

ethylate, 192 

glycerophosphate, 917 

hydroxide, 174 

hypophosphite, 915 

hyposulphite, 102 
>^iodide, 965 

nitrate, 190 

nitrite, 376 

oleate, 447 

phenosulphonate, 70 

phosphate, 179 

pyroborate, 84 

pyrophosphate, 192 

salicylate, 721 

silicate, 994 

sulphate, 179 

sulphite, 102 

sulphocarbolate, 70 

thiosulphate, 102 

valerate, 666 
Soja bean, 456 
Soporifics, 739 
Somnal, 866, 872 



Somnoform, 907 
Sozo-iodol, 74, 83 
Spanish flies, 531 
Sparteine sulphate, 522 
Spearmint, 646 
Spermace'ti, 440 
Spige'lia, 121 
Spinal cocainization, 763 

cord, drugs acting on, 
735, 112 
Spindle tree, 697 
Sphacelic acid, 919 
Spirit of Mindererus, 206 

nitrous ether, 378 

proof, 824 

of wine, 824 
Spi'ritus se'theris nitro'si, 
378 

frume'nti, 824 

vi'ni ga'llici, 824 
Splenic extract, 958 
Sponging, cold, 518 
Sprays, 4 
Squaw root, 928 
Squill, 279 
Squire's chemical food, 

233 
Staphisa'gria, 125 
Star-anise, 646 
Starch, 476 
Stavesacre, 125 
Stearates, 438 
Stearic acid, 438 
Stilli'ngia, 977 
Stimulants, cerebral, 738 

hepatic, 625 
Stomach, drugs acting on, 

609, 627 
Stomachics, 609, 627 
Sto'rax, 595 
Stramo'nium, 818 
Strangury, 350, 533 
Strengthening plaster, 223 
Streptococcus antitoxin, 

938 
Stro'ntium, 529 

bromide, 792 

iodide, 966 

lactate, 529 

salicylate, 721 
Strophanthin, 272 
Stropha'nthus, 272 



INDEX. 



1009 



Strychnine, 772 
Styptics, 328 
Styrax, 595 
Styrone, 596 
Sublimate, corrosive, 19 
Sucrol, 552 
Sucrose, 459 
Sudorifics, 494 
Suet, prepared, 990 
Sugar, 459 

drugs causing it in 
urine, 626 
Sulphonal, 878 
Sulphonethylmethane, 880 
Sulphonmethane, 878 
Su'lphur, 98 

iodide, 103 

lo'tum, 98 

precipitated, 98 

sublimed, 98 

vegetable, 991 

washed, 98 
Sumach, 399 
Sumbul, 642 
Suppositories, 4 
Suprarenal extract, 949 
Sweet almond, 613 

birch, 729 

flag, 631 

oil, 447 

orange peel, 654 

spirit of nitre, 378 
Sympathetic system, drugs 

acting on, 744 
Sy'rupus, 459 

tri'um phospha'tum, 
232 
Systemic action, 3 

TABA'CUM, 749 
Taka-diastase, 456 
Talc, 993 
Tamar indien, 696 
Tamarind, 680 
Tanacetum, 932 
Tannalbin, 382, 388 
Tannigen, 382, 389 
Tannin, 382 
Tansy, 932 
Tar, 357 
Tarasp, 181 
Ta'raxacum, 635 



Tartar, emetic, 502 

cream of, 165 
Tartaric acid, 266 
Tea, 283 
Teeth, drugs acting on, 

606 
Temperature, drugs caus- 
ing rise of, 555 

drugs decreasing, 

553, 556 
Terebene, 594 
Terebi'nthina, 348 

canade'nsis, 356 
Terpin hydrate, 595 
Testicular extract, 957 
Tetanus antitoxin, 936 
Tetronal, 880 
Thalline sulphate, 567 
Thebaine, 866 
Theine, 282 
Theobro'ma, oil of, 444 
Theobromine sodio-salicy- 

late, 528 
Therapeutic actions, 8 
Therapeutics, 1 

definition of, 1 

general, 1 

rational, 1 

empirical, 1 

experimental, 2 
Therapo-dynamics, 1 
Thermogenesis, 553 
Thermolysis, 553 
Thermotaxis, 554 
Thiol, 975 

Thiersch's solution, 87 
Thompson's fluid, 87 

solution, 912 
Thorn-apple, 818 
Thoroughwort, 508 
Thus America'num, 364 
Thyme, oil of, 551 
Thy'mol, 108 

iodide, 74, 81 
Thymus extract, 953 
Thyroid extract, 946 
Thyroiodin, 946 
Tinctu'ra antiperio'dica, 
145 

laxati'va, 693 
Tobacco, 749 

Indian, 754 



Tobacco, smoking, 754 
Tolu, balsam of, 595 
Tonga, 771 

Tonic, definition of, 960 
Toxicology, definition of, 

2 
Tragacanth, 464 
Tribromomethane, 994 
Trichloromethane, 888 
Trichlor-tertiary butyl-al- 
cohol, 875 
Trimethyl amine hydro- 
chlorate, 490, 492 
Trimethylethylene, 908 
Trional, 880 
Tri'ticum, 538 
Troches, 4 
Trousseau's pill, 428 
Trunks of nerves, drugs 

acting on, 735 
Trypsin, 664 
Turpentine, 348 
Canada, 356 
Chian, 348, 356 
Turpeth mineral, 21 
Typhoid serum and inoc- 
ulations, 942 



U'LMUS, 462 
Ungue'ntum metal- 
lo'rum, 426 
Urea, drugs acting on, 

627 
Urethane, 884 

ethylated chloral, 866 
Urethra, drugs acting on, 

5i5 
Urinary system, drugs 
acting on, 509 
sedatives, 575 
antiseptics, 574 
Urine, composition al- 
tered, 514 
increased, 509 
diminished, 512 
rendered acid, 512 
alkaline, 512 
aseptic, 514 
Urotropin, 538 
Uterus, drugs acting on, 
909, 919 



IOIO 



INDEX. 



Uterine action, substances Vitriol, oil of, 329 

which depress, 910, 932 white, 423 

U'va u'rsi, 524 Volatile liniment, 194 



Wormseed, Levant, 11! 
Wormwood, 650 
Wourara, 744 



VAGUS centre, drugs 
acting on, 252, 305 
Valerian, 665 
Vallet's mass, 221 
Vani'lla, 987 
Vanillin, 987 
Vascular irritants, 325 
Vasomotor centre, drugs 

acting on, 329 
Vaso-constrictors, 327 
Vaso-dilators, 325, 329 
Vegetable cathartic pills, 

705 

mercury, 700 

sulphur, 991 
Veratrine, 316 
Vera'trum, 315 
Vermicides, 17 
Vermifuges, 17 
Veronal, 881 
Vesicants, 326 
Vessels, drugs acting on, 

324 
Vibu'rnum, 932 
Vienna paste, 215 
Villacabras, 181, 621 
Vi'num a'lbum, 824 

ru'brum, 824 
Vittell, 215 
Vitellus, 441 
Vitriol, blue, 428 



WAHOO, 697 
Warburg's tinc- 
ture, 145 
Ward's paste, 657 
Warming plaster, 362 
Wash, black, 21 

yellow, 21 
Water, 516 

distilled, 516 
Waukesha, 215 
Wax, 990 
Weight, 5 
Weld's syrup of ferric 

chloride, 225 
Whiskey, 824 
White corpuscles, drugs 
acting on, 151 

mustard, 478 

oak, 382 

petrolatum, 442 

precipitate, 19 

vitriol, 423 

wax, 990 

wine, 824 
Wildungen, 215 
Wine, red, 824 

white, 824 
Wir.tergreen, oil of, 729 
Witchhazel, 397 
Wool-fat, 438 
Wormseed, American, 122 



VANTHOXYLUM, 



973 



YELLOW DOCK, 401 
jasmine, 788 
mercuric oxide, 20 

subsulphate, 
21 
mercurous iodide, 20 
prussiate of potash, 

573 
wash, 2 1 
wax, 990 
Ye'rba Sa'nta, 603 

ZE'A, 529 
Zinc salts, 422 
Zi'nci ace'tas, 423 

bro'midum, 792 

ca'rbonas prsecipita'- 
tus, 423 

chlo'ridum, 422 

io'didum, 966 

o'xidum, 423 

phenosu'lphonas, 70 

pho'sphidum, 916 

ste'aras, 423 

su'lphas, 423 

va'leras, 665 
Zi'ncum, 422 
Zingiber, 660 






6 



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